| Coastal Community Health Services, Inc. | |
|
22385 Flora Park Crossing Drive Fernandina Beach FL 32034 | |
| (904) 404-8641 | |
| (904) 227-3246 |
| Full Name | Coastal Community Health Services, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 22385 Flora Park Crossing Drive, Fernandina Beach, Florida |
| Authorized Official Name and Position | Kavanaugh Chandler (CEO) |
| Authorized Official Contact | 9122758028 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Community Health Services, Inc. 100 Professional Center Dr Brunswick GA 31525-6743 Ph: (912) 574-5075 | Coastal Community Health Services, Inc. 22385 Flora Park Crossing Drive Fernandina Beach FL 32034 Ph: (904) 404-8641 |
| NPI Number | 1851131874 |
|---|---|
| Provider Enumeration Date | 05/28/2024 |
| Last Update Date | 05/28/2024 |
| Medicare PECOS PAC ID | 0345463683 |
|---|---|
| Medicare Enrollment ID | O20241112000857 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851131874 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | John J Kemerer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386696599 PECOS PAC ID: 4385657022 Enrollment ID: I20180518000198 |
| Provider Name | Mary Margaret Schlosser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033951389 PECOS PAC ID: 2668906702 Enrollment ID: I20241112000992 |
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