| Coastal Family Health Center, Inc - Lucedale Clinic | |
|
11231 Old 63 S Lucedale MS 39452-4941 | |
| (228) 374-2494 | |
| Not Available |
| Full Name | Coastal Family Health Center, Inc - Lucedale Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 11231 Old 63 S, Lucedale, Mississippi |
| Authorized Official Name and Position | Angelique Greer (CEO) |
| Authorized Official Contact | 2283742494 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Family Health Center, Inc - Lucedale Clinic 10467 Corporate Dr Gulfport MS 39503-4634 Ph: (228) 374-2494 | Coastal Family Health Center, Inc - Lucedale Clinic 11231 Old 63 S Lucedale MS 39452-4941 Ph: (228) 374-2494 |
| NPI Number | 1861950982 |
|---|---|
| Provider Enumeration Date | 03/07/2019 |
| Last Update Date | 08/16/2024 |
| Medicare PECOS PAC ID | 8628989654 |
|---|---|
| Medicare Enrollment ID | O20190321002192 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861950982 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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