| Coastal Carolina Care Pllc | |
|
15441 Us Highway 17 N Ste 501 Hampstead NC 28443-0016 | |
| (910) 512-2520 | |
| (910) 900-8002 |
| Full Name | Coastal Carolina Care Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 15441 Us Highway 17 N Ste 501, Hampstead, North Carolina |
| Authorized Official Name and Position | Michael Thomas (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 9106857307 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Carolina Care Pllc 831 Wine Cellar Cir Wilmington NC 28411-9298 Ph: (910) 512-2520 | Coastal Carolina Care Pllc 15441 Us Highway 17 N Ste 501 Hampstead NC 28443-0016 Ph: (910) 512-2520 |
| NPI Number | 1760027874 |
|---|---|
| Provider Enumeration Date | 11/12/2019 |
| Last Update Date | 01/23/2024 |
| Medicare PECOS PAC ID | 2264867803 |
|---|---|
| Medicare Enrollment ID | O20200505003282 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760027874 | NPI | - | NPPES |
| Provider Name | Bradford Keith Faulkenberry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518915370 PECOS PAC ID: 3678483609 Enrollment ID: I20080110000656 |
| Provider Name | Andrea Lynn Maggard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790818250 PECOS PAC ID: 4385669043 Enrollment ID: I20201214000744 |
| Provider Name | Raishael L Tessari |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902435944 PECOS PAC ID: 3375923782 Enrollment ID: I20220701000916 |
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