Coastal Carolina Health Care PA
Organization Active NPI Internal Medicine Physician · Bayboro, NC
NPI 1063962074 · NPPES record last updated Feb 1, 2024
Key facts
- NPI
- 1063962074
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- COASTAL CAROLINA HEALTH CARE PA
- Practice address
- 606 Main St
Bayboro, NC 28515-9632 - Phone
- (252) 745-3191
- NPI assigned
- Oct 13, 2016
- Organization subpart
- No
Authorized official
- Name
- Stephen W Nuckolls
- Title
- Ceo
- Phone
- (252) 514-6685
Other NPIs on the same Medicare enrollment 18
Practitioners 11
-
Floriece Graham Blackmon, M.D.
-
Patrick Sean Carroll, PAC
-
Shanna Kornegay Corley, FNP-C
-
Casey Dawn Elliott, FNP-C
-
Hughes Montgomery Helm, M.D.
-
Maureen Ann Jones, FNP
-
Suman Lamsal, MD
-
Mallory Moore, DNP, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031230000224 | NC | Part B Supplier - Clinic/Group Practice | 9739087693 |
Receives reassigned benefits from 137 practitioners 23 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: New Bern, NC; Morehead City, NC; Havelock, NC; Bayboro, NC |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes | ||
| Primary Care Clinic/Center | 261QP2300X |
Addresses
Primary practice location
606 Main St
Bayboro, NC 28515-9632
Mailing address
606 Main St
Bayboro, NC 28515-9632
Phone (252) 745-3191
Other names
- CCHC Pamlico Medical Center
Other providers in Bayboro, NC
- Robert Michael Bero II
- Linda Jan Boothe
- C. Kelly Holdings, Inc
- Stephanie Demetra Carperos
- Margaret L Choate
- Coastal Regional Health & Wellness, PLLC
- County of Pamlico
- County of Pamlico
- County of Pamlico
- County of Pamlico
All providers in Bayboro, NC · Internal Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.