Organization
COASTAL FAMILY HEALTH CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGELIQUE GREER (EXECUTIVE DIRECTOR)
(228) 374-2494
Entity
Organization
Contact information
Practice address
951 MAIN ST, LEAKESVILLE, MS 39451-5622
(601) 394-2381
(601) 394-2593
Mailing address
10467 CORPORATE DR, GULFPORT, MS 39503-4634
(228) 374-2494
(228) 374-2713
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09010030
—
MS
01
—
C01007
MS MEDICARE
MS
Enumeration date
09/07/2006
Last updated
08/16/2024
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