NPIMap

Organization Active NPI

Coastal Carolina Multispecialty Assocs, LLC

  • Specialist
  • North Charleston, SC
National Provider Identifier
1184730749
Registry record updated Oct 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
COASTAL CAROLINA MULTISPECIALTY ASSOCS, LLC
Practice address
9221 University Blvd
Suite 102
North Charleston, SC 29406-9148
Phone
(843) 576-0700
Fax
(843) 576-0701
NPI assigned
Aug 23, 2006
Last updated
Oct 31, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2007

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

Authorized official

Name
Mark Pickett
Title
Vice-President of Operations
Phone
(678) 762-5037

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

9221 University Blvd
Suite 102
North Charleston, SC 29406-9148

Mailing address

9221 University Blvd
Suite 102
North Charleston, SC 29406-9148
Phone (843) 576-0700

Other identifiers 1

IdentifierTypeStateIssuer
GP 4508MedicaidSC

National Provider Directory

National Provider Directory

Locations

9221 University Blvd
Ste 102
North Charleston, SC 29406
Phone (843) 576-0700

Practitioners & affiliated clinicians

Practitioners 46

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.

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193788800000",
    "number": "1184730749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9221 UNIVERSITY BLVD",
            "address_2": "SUITE 102",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069148",
            "telephone_number": "843-576-0700",
            "fax_number": "843-576-0701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9221 UNIVERSITY BLVD",
            "address_2": "SUITE 102",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069148",
            "telephone_number": "843-576-0700",
            "fax_number": "843-576-0701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA MULTISPECIALTY ASSOCS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2007-10-31",
        "status": "A",
        "authorized_official_last_name": "PICKETT",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "VICE-PRESIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "678-762-5037"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP 4508",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2007; 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.