Organization
COASTAL PAIN CARE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG A CHARLESTON MD (OWNER)
(409) 892-4600
Entity
Organization
Contact information
Practice address
755 N 11TH ST, SUITE P2280, BEAUMONT, TX 77702-1501
(409) 892-4600
(409) 892-4605
Mailing address
755 N 11TH ST, SUITE P2280, BEAUMONT, TX 77702-1501
(409) 892-4600
(409) 892-4605
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
TX
208VP0014X
Interventional Pain Medicine Physician
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0027MW
BLUE CROSS
TX
05
—
175364201
—
TX
Enumeration date
11/21/2005
Last updated
08/02/2011
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