NPIMap

Organization Active NPI

Coastal Family Health Center, Inc.

Doing business as Coastal Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Moss Point, MS
National Provider Identifier
1508897000
Registry record updated Apr 8, 2025
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
Practice address
4913 Weems Street
Moss Point, MS 39563
Phone
(228) 474-7103
Fax
(228) 474-7103
NPI assigned
Jul 5, 2006
Last updated
Apr 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2025

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

Authorized official

Name
Angelique S Greer
Title
Executive Director
Phone
(228) 374-2494

Specialties & licenses 1

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

Addresses

Primary practice location

4913 Weems Street
Moss Point, MS 39563

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
01903304MedicaidMS
C00895OtherMSMEDICARE

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
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…

Other NPIs on the same Medicare enrollment 37

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

View all 37

National Provider Directory

National Provider Directory

Locations

10828 Highway 57
Vancleave, MS 39565
Phone (228) 826-4711

Practitioners & affiliated clinicians

Practitioners 1

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": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744070400000",
    "number": "1508897000",
    "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": "228-374-0856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4913 WEEMS STREET",
            "city": "MOSS POINT",
            "state": "MS",
            "postal_code": "39563",
            "telephone_number": "228-474-7103",
            "fax_number": "228-474-7103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL FAMILY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A",
        "authorized_official_last_name": "GREER",
        "authorized_official_first_name": "ANGELIQUE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "228-374-2494"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01903304",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "C00895",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moss Point, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2025; 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.