NPIMap

Organization Active NPI

Coastal Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Saucier, MS
National Provider Identifier
1487686580
Registry record updated Aug 22, 2020
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
Doing business as
Coastal Family Health Center
Practice address
23457A Central Drive
Saucier, MS 39574
Phone
(228) 832-7223
Fax
(228) 832-0657
NPI assigned
Jul 7, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Joe M Dawsey
Title
Executive Director
Phone
(228) 818-2766

Specialties & licenses 1

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

Addresses

Primary practice location

23457A Central Drive
Saucier, MS 39574

Mailing address

PO Box 475
Biloxi, MS 39533
Phone (228) 818-2766

Other identifiers 1

IdentifierTypeStateIssuer
09010021MedicaidMS

Other names 1

  • Coastal Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031103000577 MS Part A Provider - Federally Qualified Health Center (FQHC) 8628989654 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saucier, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487686580. Details of each certification follow.

Federally qualified health center certification: CCN 251920

Legal name
COASTAL FAMILY HEALTH CENTER, INC
Doing business as
COASTAL FAMILY HEALTH CENTER - SAUCIER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 4, 2003
Last certification
Nov 4, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 25, 1978 in MS
Enrollment address
23453 Central Dr
Saucier, MS 39574-7521
Related CCNs
251811

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

23457A Central Dr
Saucier, MS 39574
Phone (228) 832-7223

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Judy a Grant Individual Corporate DirectorBoard Member Jun 1, 2013
Xuan Phan Individual Corporate Director Jan 1, 2021
Kwantrell D Green Individual Corporate DirectorBoard Member Jun 1, 2009
Roy a Tolbert Individual Corporate DirectorBoard Member Jun 1, 2012
Bertha J Oatis Individual Corporate DirectorBoard Member Jun 1, 2009
Paulette T Briscoe Individual Corporate DirectorBoard Member Jun 1, 2009
Christine M McLeod Individual Corporate Director Jan 1, 2021
Angelique S Greer Individual Corporate OfficerCeo Aug 1, 2010
W-2 Managing Employee Aug 1, 2010
Xenia G Wickline Individual Corporate Director Jan 1, 2021
Jane Campbell Individual Corporate Director Jan 1, 2021
Shelby Ward Individual Corporate Director Jan 1, 2021
Shirley Leist Individual Corporate Director Jan 1, 2021
Joseph P Hudson Individual Corporate DirectorBoard Members Jun 1, 2011

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": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487686580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 475",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "39533",
            "telephone_number": "228-818-2766",
            "fax_number": "228-818-2394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23457A CENTRAL DRIVE",
            "city": "SAUCIER",
            "state": "MS",
            "postal_code": "39574",
            "telephone_number": "228-832-7223",
            "fax_number": "228-832-0657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAWSEY",
        "authorized_official_first_name": "JOE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "228-818-2766"
    },
    "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": "09010021",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saucier, MS

Sources for this page

Verify at the official NPI Registry.