Coastal States Management

Primary specialty

SpecialistTaxonomy code 174400000X

License

D0459 Issued in AL

Legal business name

COASTAL STATES MANAGEMENT

Doing business as

southeastern pain management

Practice address

1026 Goodyear Ave
BLDG 400, Ste 302
Gadsden, AL 35903-1102

Phone

(256) 492-7246

Fax

(256) 492-1186

NPI assigned

Aug 4, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Mary Katherine Jacobs

Title

Chief Operating Officer

Phone

(256) 492-7246

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• southeastern pain management Doing business as

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295743078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1026 GOODYEAR AVE",
            "address_2": "BLDG 400, STE 302",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359031102",
            "telephone_number": "256-492-7246",
            "fax_number": "256-492-1186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1026 GOODYEAR AVE",
            "address_2": "BLDG 400, STE 302",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359031102",
            "telephone_number": "256-492-7246",
            "fax_number": "256-492-1186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL STATES MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "KATHERINE",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "256-492-7246",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AL",
            "license": "D0459",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00145166",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "southeastern pain management",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Judy Taylor Clontz, MS
• Megan Ford Clough, BEHAVIOR ANALYST
• Timothy Kitt Coan, RPT
• Coastal Health Care, Inc (Coastal Healthcare)
• Coastal States Managemen (southeastern pain managment)
• Coastal States Management (Southeastern Pain Management)
• Mark Jason Cobb, CRNP - AGACNP-BC
• Kelly Waits Cochran, CRNA
• Jacob Cofield
• Tyler M Coggin, CRNA

• Specialist in Gadsden, AL
• Providers in Gadsden, AL by specialty
• Specialist in Alabama

• 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.