Coastal Pain Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

COASTAL PAIN CENTER, LLC

Practice address

306 Isabella St
Waycross, GA 31501-3636

Phone

(912) 466-9111

NPI assigned

May 15, 2017

Last updated

May 15, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

COASTAL PAIN CENTER, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kevin Coyle, MDNPI 1891883765

Title

Owner/Physician

Phone

(912) 466-9111

Specialties & licenses 1

Addresses

Part of

Coastal Pain Center LLC

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Coastal Pain Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Brunswick, GA
  • NPI 1740336577
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin Don Coyle, MB BCH BAO LRCPSI

  • Interventional Pain Medicine Physician
  • Brunswick, GA
  • NPI 1891883765
  NPD Authorized official
• Thomas E. Runyan, MD

  • Anesthesiology Physician
  • Brunswick, GA
  • NPI 1467493999
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1494806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494806400000",
    "number": "1114454634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3221 GLYNN AVE",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 ISABELLA ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315013636",
            "telephone_number": "912-466-9111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PAIN CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COASTAL PAIN CENTER, LLC",
        "enumeration_date": "2017-05-15",
        "last_updated": "2017-05-15",
        "status": "A",
        "authorized_official_last_name": "COYLE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "912-466-9111",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Spurgeon William Clark III, M. D.
• Clinical Diagnostic Services
• CLS Comp
• Coastal Care Inc
• Coastal Health Services, Inc. (Waycross Health and Rehabilitation Center)
• Aristotle Cochon, M.D.
• Cole Vision Corporation
• Jamie Coleman, FNP-BC
• Columbus Medical Services (Columbus Community Services)
• Concerted Services, Inc.

• Ambulatory Surgical Clinic/Center in Waycross, GA
• Providers in Waycross, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.