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COASTAL CAROLINA MULTISPECIALTY ASSOCIATES LLC NPI 1518079102


NPI Information

NPI: 1518079102
Provider Name: COASTAL CAROLINA MULTISPECIALTY ASSOCIATES, LLC

Doing Business As: COASTAL CAROLINA SURGICAL SPECIALISTS

Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 42D0251420

Address:
295A MIDLAND PKWY STE 120
SUMMERVILLE, SC
ZIP 29485
Phone: (843) 875-8994
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COASTAL CAROLINA MULTISPECIALTY ASSOCIATES, LLC is a specialist in Summerville, SC. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. COASTAL CAROLINA MULTISPECIALTY ASSOCIATES, LLC NPI is 1518079102. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Coastal Carolina Surgical Specialists.

The provider's business location address is:

295A MIDLAND PKWY STE 120
SUMMERVILLE, SC
ZIP 29485-901
Phone: (843) 875-8994

The provider's authorized official is Robert Faile .
The authorized official title is Vice President and has the following contact phone number (843) 856-7923.

The CLIA number assigned to this NPI record is 42D0251420 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/31/2006 and was last updated on 1/21/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207RC0000XInternal MedicineCardiovascular DiseaseNo
2207RI0011XInternal MedicineInterventional CardiologyNo
3207V00000XObstetrics & GynecologyNo
4207X00000XOrthopaedic SurgeryNo
52085R0001XRadiologyRadiation OncologyNo
6208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery)No
7174400000XSpecialistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1GP4508MEDICAIDSOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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