| Coastal Family Health Center, Inc -state Line Medical Center | |
|
256 Main St State Line MS 39362-9499 | |
| (601) 848-7912 | |
| (601) 848-7461 |
| Full Name | Coastal Family Health Center, Inc -state Line Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 256 Main St, State Line, 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 -state Line Medical Center 10467 Corporate Dr Gulfport MS 39503-4634 Ph: (228) 374-2494 | Coastal Family Health Center, Inc -state Line Medical Center 256 Main St State Line MS 39362-9499 Ph: (601) 848-7912 |
| NPI Number | 1528161197 |
|---|---|
| Provider Enumeration Date | 09/07/2006 |
| Last Update Date | 08/16/2024 |
| Medicare PECOS PAC ID | 8628989654 |
|---|---|
| Medicare Enrollment ID | O20170511000775 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528161197 | NPI | - | NPPES |
| 09228250 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Friends Of Children State Line Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 82 Church Street, State Line, MS 39451 Phone: 601-848-7650 |