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Organization

COASTAL CAROLINA SURGICAL ASSOC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. LORI NOEL MOCK (PRACTICE ADMINISTRATOR)
(843) 524-8171
Entity
Organization

Contact information

Practice address
1055 RIBAUT ROAD, SUITE 30, BEAUFORT, SC 29902-5447
(843) 524-8171
(843) 525-6613
Mailing address
1055 RIBAUT ROAD, SUITE 30, BEAUFORT, SC 29902-5447
(843) 524-8171
(843) 525-6613

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2086S0129X
Vascular Surgery Physician
Primary

Other

Enumeration date
12/18/2006
Last updated
09/11/2025
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