Organization
COASTAL FAMILY HEALTH CENTER, INC.
Active
Other names
Coastal Family Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELIQUE S GREER (CEO)
(228) 374-2494
Entity
Organization
Contact information
Practice address
15024 MARTIN LUTHER KING JR BLVD, GULFPORT, MS 39501-8306
(228) 864-0003
(228) 863-7917
Mailing address
10467 CORPORATE DR, GULFPORT, MS 39503-4634
(228) 374-2494
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09013184
—
MS
01
—
C00895
MS/MEDICARE/CAHABA
MS
Enumeration date
07/03/2006
Last updated
08/16/2024
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