National Provider Identifier Database

COASTAL PHYSICAL MEDICINE PA
Medical Specialty

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).


Contact Information

COASTAL PHYSICAL MEDICINE, PA
3185 AZALEA DR
NORTH CHARLESTON, SC29405-8211
Phone: 843-762-2274
Fax: 843-762-2278
Website:
Specialty Taxonomy Code
* Medical Specialty 261QM2500X

* Indicates primary specialty

NPI Profile & details for COASTAL PHYSICAL MEDICINE, PA

NPI Number 1053580662
Legal business name
LBN
COASTAL PHYSICAL MEDICINE, PA
Authorized official REBECCA MCSWAIN - (PRACTICE MANAGER)
Entity Organization
Organization subpart No
Enumeration date 02/27/2008
Last updated 02/27/2008 - About 18 years ago
Sole proprietor1 Not specified
Identifiers
  • SC License #: 19612
  • SC Medicaid: GP2989

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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