NPIMap

Organization Active NPI

Coastal Family Health Center Inc

Doing business as Coastal Family Health Center, Inc - Junior High School Clinic

  • Federally Qualified Health Center (FQHC)
  • Leakesville, MS
National Provider Identifier
1457444606
Registry record updated Aug 16, 2024
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 - Junior High School Clinic
Practice address
620 Main Street
Leakesville, MS 39451
Phone
(601) 394-4507
Fax
(601) 394-5615
NPI assigned
Oct 2, 2006
Last updated
Aug 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

620 Main Street
Leakesville, MS 39451

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
08703746MedicaidMS

Other names 1

  • Coastal Family Health Center, Inc - Junior High School Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040108000698 MS Part B Supplier - Clinic/Group Practice 8628989654 Receives reassigned benefits from 90 practitioners
37 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: MC Lain, MS; Moss Point, MS; Ocean Springs, MS; Pass Christian, MS; Richton, MS; State Line, MS; Vancleave, MS; Waveland, MS…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457444606. Details of each certification follow.

  • CCN 251930 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 251930

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
COASTAL FAMILY HEALTH CENTER INC - JR HS CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 15, 2004
Last certification
Jan 15, 2004
Ownership / control type
For profit – corporation
Most recent change of ownership
Jan 1, 2017 (2 total)
Facility address
620 Main Street
Leakesville, MS 39451
Related CCNs
251822

Other NPIs on the same Medicare enrollment 37

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 37

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
25D2048973Coastal Family Health Center-Leakesville Junior Hi620 Main Street, Leakesville, MS 39451Certificate of waiverOct 25, 2026

National Provider Directory

National Provider Directory
Tax ID family
Coastal Family Health Center Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

256 Main St
State Line, MS 39362
Phone (601) 848-7912

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1457444606",
    "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",
            "fax_number": "228-374-2713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 MAIN STREET",
            "city": "LEAKESVILLE",
            "state": "MS",
            "postal_code": "39451",
            "telephone_number": "601-394-4507",
            "fax_number": "601-394-5615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL FAMILY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "GREER",
        "authorized_official_first_name": "ANGELIQUE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "228-374-2494",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08703746",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Family Health Center, Inc - Junior High School Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Leakesville, MS

Sources for this page

Verify at the official NPI Registry.