| Coast To Coast Medical, Llc | |
|
2201 Horizon Drive Suite 4 West Memphis AR 72301 | |
| (870) 732-0332 | |
| (870) 732-3078 |
| Full Name | Coast To Coast Medical, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2201 Horizon Drive, West Memphis, Arkansas |
| Authorized Official Name and Position | Debra J Shivers (PROVIDER) |
| Authorized Official Contact | 8707320332 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coast To Coast Medical, Llc 2201 Horizon Drive Suite 4 West Memphis AR 72301 Ph: (870) 732-0332 | Coast To Coast Medical, Llc 2201 Horizon Drive Suite 4 West Memphis AR 72301 Ph: (870) 732-0332 |
| NPI Number | 1740214402 |
|---|---|
| Provider Enumeration Date | 07/10/2006 |
| Last Update Date | 12/02/2008 |
| Medicare PECOS PAC ID | 3274606314 |
|---|---|
| Medicare Enrollment ID | O20080722000574 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740214402 | NPI | - | NPPES |
| 5C471 | Other | AR | AR BCBS GROUP # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Joseph M Patterson |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1063486413 PECOS PAC ID: 1052356672 Enrollment ID: I20050623001045 |
| Provider Name | Lisa A Schafer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174791081 PECOS PAC ID: 5597832287 Enrollment ID: I20080922000624 |
| Provider Name | Lance Michael Harrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447407671 PECOS PAC ID: 4385712033 Enrollment ID: I20081007000837 |
| Provider Name | Victoria Elizabeth Hollis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639781396 PECOS PAC ID: 1052723442 Enrollment ID: I20201208002544 |
| Provider Name | Leah M Carlson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942977301 PECOS PAC ID: 1456759091 Enrollment ID: I20220408001023 |
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