Coastal Skilled Care Providers LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME98984 Issued in FL

Legal business name

COASTAL SKILLED CARE PROVIDERS LLC

Practice address

767 Timothy St
Ormond Beach, FL 32174-2909

Phone

(407) 496-9399

NPI assigned

Jul 9, 2014

Last updated

Jul 9, 2014By 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

Dr. Lothar Michael Gebauer, MD

Title

Officer

Phone

(407) 496-9399

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1404864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404864000000",
    "number": "1508272683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "767 TIMOTHY ST",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321742909",
            "telephone_number": "407-496-9399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "767 TIMOTHY ST",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321742909",
            "telephone_number": "407-496-9399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL SKILLED CARE PROVIDERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-09",
        "last_updated": "2014-07-09",
        "status": "A",
        "authorized_official_last_name": "GEBAUER",
        "authorized_official_first_name": "LOTHAR",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "407-496-9399",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME98984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coastal Internal Medicine Specialists LLC
• Coastal Neurology, Inc. (Coastal Pain Mgmt, Neurology & Rehabilitation)
• Coastal Oncology PL
• Coastal Pediatrics
• Coastal Pediatrics LLC
• Coastal Speech and Language Center, LLC
• Shawn Michael Coates, RPH
• Melissa Sue Cobb, DPT
• Gabrielle Cochran
• Mary Dolores Cocks

• Internal Medicine Physician in Ormond Beach, FL
• Providers in Ormond Beach, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2014; 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.