NPIMap

Organization Active NPI

Coastal Vascular and Interventional PLLC

  • Vascular Surgery Physician
  • Fort Walton Beach, FL
National Provider Identifier
1164091005
Registry record updated Jun 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
COASTAL VASCULAR AND INTERVENTIONAL PLLC
Practice address
1032 Mar Walt Dr Unit 250
Fort Walton Beach, FL 32547-6663
Phone
(850) 479-1805
Fax
(850) 479-1829
NPI assigned
Jun 24, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2021

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

Authorized official

Name
Danelle Fischer
Title
Administrator
Phone
(850) 479-1805

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

1032 Mar Walt Dr Unit 250
Fort Walton Beach, FL 32547-6663

Mailing address

PO Box 11982
Pensacola, FL 32524-1982
Phone (850) 479-1805

National Provider Directory

National Provider Directory
Tax ID family
Coastal Vascular and Interventional PLLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1624492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624492800000",
    "number": "1164091005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11982",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325241982",
            "telephone_number": "850-479-1805",
            "fax_number": "850-479-1829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 MAR WALT DR UNIT 250",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476663",
            "telephone_number": "850-479-1805",
            "fax_number": "850-479-1829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL VASCULAR AND INTERVENTIONAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-24",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A",
        "authorized_official_last_name": "FISCHER",
        "authorized_official_first_name": "DANELLE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "850-479-1805"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2021; 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.