Coastal Pediatric Care, Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

COASTAL PEDIATRIC CARE, INC

Practice address

212 N 35TH St
Morehead City, NC 28557-3104

Phone

(252) 247-5212

Fax

(252) 247-1034

NPI assigned

Sep 29, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Betty W Wallace, RN, MSN, PNP

Title

Owner

Phone

(252) 247-5212

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235126830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 N 35TH ST",
            "city": "MOREHEAD CITY",
            "state": "NC",
            "postal_code": "285573104",
            "telephone_number": "252-247-5212",
            "fax_number": "252-247-1034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 N 35TH ST",
            "city": "MOREHEAD CITY",
            "state": "NC",
            "postal_code": "285573104",
            "telephone_number": "252-247-5212",
            "fax_number": "252-247-1034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PEDIATRIC CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "BETTY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-247-5212",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, MSN, PNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7000101",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Morehead City, NC
• Providers in Morehead City, NC by specialty
• Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.