NPIMap

Organization Active NPI

Coastal Family Health Center, Inc

Doing business as Coastal Family Health Center, Inc LT Taylor Intermediate

  • Federally Qualified Health Center (FQHC)
  • Lucedale, MS
National Provider Identifier
1265226765
Registry record updated Apr 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COASTAL FAMILY HEALTH CENTER, INC
Doing business as
Coastal Family Health Center, Inc
Coastal Family Health Center, Inc LT Taylor Intermediate
Practice address
159 Mable St
Lucedale, MS 39452-5821
Phone
(228) 374-2494
NPI assigned
Apr 8, 2025
Last updated
Apr 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2025

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

Authorized official

Name
Angelique S Greer
Title
Ceo
Phone
(228) 374-2494

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

159 Mable St
Lucedale, MS 39452-5821

Mailing address

10467 Corporate Dr
Gulfport, MS 39503-4634
Phone (228) 374-2494

Other names 2

  • Coastal Family Health Center, Inc Doing business as
  • Coastal Family Health Center, Inc LT Taylor Intermediate Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260520001866 MS Part A Provider - Federally Qualified Health Center (FQHC) 8628989654 Practice locations: Lucedale, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265226765. Details of each certification follow.

Federally qualified health center certification: CCN 251189

Legal name
COASTAL FAMILY HEALTH CENTER, INC
Doing business as
COASTAL FAMILY HEALTH CENTER- LT TAYLOR
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 18, 2026
Last certification
May 18, 2026
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
159 Mable St
Lucedale, MS 39452-5821

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2069439LT Taylor Intermediate159 Mable Street, Lucedale, MS 39452Certificate of waiverAug 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Coastal Family Health C54 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 22

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 22

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Angelique S Greer Individual Corporate DirectorCeo Aug 11, 2025
W-2 Managing EmployeeCeo Aug 11, 2025

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Coastal Family Health Center, Inc - North Bay Elementary School ClinicBay St Louis, MS, CCN 251120 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center, Inc - Bay High School ClinicBay St Louis, MS, CCN 251123 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - Waveland Elementary School ClinicWaveland, MS, CCN 251126 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - East Central Upper Elementary SchooMoss Point, MS, CCN 251125 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - Bay Waveland Middle SchoolBay St Louis, MS, CCN 251124 Federally qualified health center Operational/Managerial Control (100%) Feb 9, 2022
Coastal Family Health Center, Inc-Vancleave Upper Elementary ClinicVancleave, MS, CCN 251127 Federally qualified health center Operational/Managerial Control Nov 1, 2021

NPI Registry JSON

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

{
    "created_epoch": "1744070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744070400000",
    "number": "1265226765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10467 CORPORATE DR",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034634",
            "telephone_number": "228-374-2494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 MABLE ST",
            "city": "LUCEDALE",
            "state": "MS",
            "postal_code": "394525821",
            "telephone_number": "228-374-2494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-08",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A",
        "authorized_official_last_name": "GREER",
        "authorized_official_first_name": "ANGELIQUE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "228-374-2494"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Family Health Center, Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coastal Family Health Center, Inc LT Taylor Intermediate",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lucedale, MS

Sources for this page

Verify at the official NPI Registry.