Coastal Family Health Center, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Biloxi, MS
NPI 1558026328 · NPPES record last updated Aug 16, 2024
Key facts
- NPI
- 1558026328
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COASTAL FAMILY HEALTH CENTER, INC
- Practice address
- 16308 Lemoyne Blvd
Biloxi, MS 39532-5017 - Phone
- (228) 374-2494
- NPI assigned
- Nov 5, 2021
- Organization subpart
- No
Authorized official
- Name
- Angelique Greer
- Title
- Ceo
- Phone
- (228) 374-2494
Other NPIs on the same Medicare enrollment 37
Corporate family (same tax ID) 24
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS
Federally qualified health center certification: CCN 251118
- Legal name
- COASTAL FAMILY HEALTH CENTER, INC
- Doing business as
- COASTAL FAMILY HEALTH CENTER, INC - ST MARTIN NORTH SCHOOL
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Dec 7, 2021
- Last certification
- Dec 7, 2021
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 25, 1979 in MS
- Enrollment address
- 16308 Lemoyne Blvd
Biloxi, MS 39532-5017
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Judy a Grant |
Corporate Director | Nov 1, 2021 | |
| Xuan Phan |
Corporate Director | Nov 1, 2021 | |
| Kwantrell D Green |
Corporate Director | Nov 1, 2021 | |
| Roy a Tolbert |
Corporate Director | Nov 1, 2021 | |
| Bertha J Oatis |
Corporate Director | Nov 1, 2021 | |
| Paulette T Briscoe |
Corporate Director | Nov 1, 2021 | |
| Christine M McLeod |
Corporate Director | Nov 1, 2021 | |
| Angelique S Greer |
Corporate Director | Nov 1, 2021 | |
| W-2 Managing Employee | Nov 1, 2021 | ||
| Operational/Managerial Control | Nov 1, 2021 | ||
| Xenia G Wickline |
Corporate Director | Nov 1, 2021 | |
| Jane Campbell |
Corporate Director | Nov 1, 2021 | |
| Shelby Ward |
Corporate Director | Nov 1, 2021 | |
| Joseph P Hudson |
Corporate Director | Nov 1, 2021 |
All facility ownership & control disclosures 6
| Facility | Type | Role | Since |
|---|---|---|---|
| Coastal Family Health Center, Inc - North Bay Elementary School Clinic |
Federally qualified health center | Operational/Managerial Control | Nov 1, 2021 |
| Coastal Family Health Center, Inc - Bay High School Clinic |
Federally qualified health center | Operational/Managerial Control | Nov 1, 2021 |
| Coastal Family Health Center Inc - Waveland Elementary School Clinic |
Federally qualified health center | Operational/Managerial Control | Nov 1, 2021 |
| Coastal Family Health Center Inc - East Central Upper Elementary Schoo |
Federally qualified health center | Operational/Managerial Control | Nov 1, 2021 |
| Coastal Family Health Center Inc - Bay Waveland Middle School |
Federally qualified health center | Operational/Managerial Control (100%) | Feb 9, 2022 |
| Coastal Family Health Center, Inc-Vancleave Upper Elementary Clinic |
Federally qualified health center | Operational/Managerial Control | Nov 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
| O20211207000324 | MS | Part a Provider - Federally Qualified Health Center (FQHC) | 8628989654 | Practice locations: Biloxi, MS |
National Provider Directory
- Tax ID family
- Coastal Family Health Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
16308 Lemoyne Blvd
Biloxi, MS 39532-5017
Mailing address
10467 Corporate Dr
Gulfport, MS 39503-4634
Phone (228) 374-2494
Other names
- Coastal Family Health Center, Inc - St Martin North Elementary School
Other providers in Biloxi, MS
- Coastal Family Health Center
- Coastal Family Health Center, Inc
- Coastal Family Health Center, Inc
- Coastal Family Health Center, Inc
- Coastal Family Health Center, Inc
- Coastal Family Health Center, Inc
- Coastal Family Health Center, Inc
- Coastal Family Health Center, Inc
- Coastal Family Health Center, Inc.
- Coastal Family Health Center, Inc.
All providers in Biloxi, MS · Federally Qualified Health Center (FQHC) in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.