NPI:
1700979960
Provider Name:
COASTAL FAMILY HEALTH CENTER, INC
Other Name: COASTAL FAMILY HEALTH CENTER, INC - ANNEX SCHOOL CLINIC
Classification:
Clinic/Center - 261QF0400X
Entity Type:
Organization
Specialization: Federally Qualified Health Center (FQHC)
CLIA Number: 25D0972439
Address:
175 ANNEX RD
LEAKESVILLE, MS
ZIP 39451
Phone:
(601) 394-5093
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COASTAL FAMILY HEALTH CENTER, INC is a federally qualified health center (fqhc) clinic center in Leakesville, MS. COASTAL FAMILY HEALTH CENTER, INC NPI is 1700979960. The provider is registered as an organization entity type.
The provider Other Name Is Coastal Family Health Center, Inc - Annex School Clinic.
The provider's business location address is:
175 ANNEX RD
LEAKESVILLE, MS
ZIP 39451-602
Phone: (601) 394-5093
Fax: (601) 394-6061
The provider's authorized official is Angelique Greer .
The authorized official title is Ceo and has the following contact phone number (228) 374-2494.
The CLIA number assigned to this NPI record is 25D0972439 - school/student health service with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 10/2/2006 and was last updated on 4/24/2018.