NPI:
1861950982
Provider Name:
COASTAL FAMILY HEALTH CENTER, INC
Doing Business As: COASTAL FAMILY HEALTH CENTER, INC - LUCEDALE CLINIC
Classification:
Clinic/Center - 261QF0400X
Entity Type:
Organization
Specialization: Federally Qualified Health Center (FQHC)
CLIA Number: 25D2166207
Address:
11231 OLD 63 S
LUCEDALE, MS
ZIP 39452
Phone:
(228) 374-2494
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COASTAL FAMILY HEALTH CENTER, INC is a federally qualified health center (fqhc) clinic center in Lucedale, MS. COASTAL FAMILY HEALTH CENTER, INC NPI is 1861950982. The provider is registered as an organization entity type.
The provider Is Doing Business As Coastal Family Health Center, Inc - Lucedale Clinic.
The provider's business location address is:
11231 OLD 63 S
LUCEDALE, MS
ZIP 39452-941
Phone: (228) 374-2494
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 25D2166207 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).
The enumeration date for this NPI number is 3/7/2019 and was last updated on 10/8/2021.