NPIMap

Organization Active NPI

Coastal Carolina Pathology, PA

  • Clinical Medical Laboratory
  • Wilmington, NC
National Provider Identifier
1497724991
Registry record updated Jul 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
COASTAL CAROLINA PATHOLOGY, PA
Practice address
2606 Iron Gate Dr
Suite 201
Wilmington, NC 28412-2573
Phone
(910) 395-4441
Fax
(910) 395-7074
NPI assigned
Mar 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2013

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

Authorized official

Name
Mrs. Kathryn J Laird
Title
Office Administrator
Phone
(910) 395-4441

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

2606 Iron Gate Dr
Suite 201
Wilmington, NC 28412-2573

Mailing address

2606 Iron Gate Dr
Suite 201
Wilmington, NC 28412-2494
Phone (910) 395-4441

Other identifiers 3

IdentifierTypeStateIssuer
690009530OtherRAILROAD MEDICARE
7001210MedicaidNC
014KUOtherNCBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040115000377 NC Part B Supplier - Independent Clinical Laboratory 6103727979 Practice locations: Wilmington, NC

National Provider Directory

National Provider Directory
Tax ID family
Coastal Carolina Pathology2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

2606 Iron Gate Dr
Ste 201
Wilmington, NC 28412
Phone (910) 395-4441

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373414400000",
    "number": "1497724991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2606 IRON GATE DR",
            "address_2": "SUITE 201",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284122494",
            "telephone_number": "910-395-4441",
            "fax_number": "910-395-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2606 IRON GATE DR",
            "address_2": "SUITE 201",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284122573",
            "telephone_number": "910-395-4441",
            "fax_number": "910-395-7074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA PATHOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-16",
        "last_updated": "2013-07-10",
        "status": "A",
        "authorized_official_last_name": "LAIRD",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "910-395-4441",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "690009530",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7001210",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "014KU",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.