NPIMap

Organization Active NPI

Coastal Family Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Moss Point, MS
National Provider Identifier
1619465705
Registry record updated Aug 16, 2024
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
Practice address
4208 Jamestown Rd
Moss Point, MS 39563-9540
Phone
(228) 474-3300
NPI assigned
Apr 25, 2018
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Angelique Greer
Title
Ceo
Phone
(228) 374-2494

Other NPIs on the same Medicare enrollment 37

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

View all 37

Practitioners 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2159162Coastal Family Health Escatawpa School Clin4208 Jamestown Road, Moss Point, MS 39563Certificate of waiverDec 11, 2026

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

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…
O20180523002223 MS Part A Provider - Federally Qualified Health Center (FQHC) 8628989654 Practice locations: Moss Point, MS

Federally qualified health center certification: CCN 251073

Legal name
COASTAL FAMILY HEALTH CENTER, INC
Doing business as
COASTAL FAMILY HEALTH CENTER, INC - ESCATAWPA SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 21, 2018
Last certification
May 21, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 25, 1978 in MS
Enrollment address
4208 Jamestown Rd
Moss Point, MS 39563-9540

All disclosed owners & managing parties 12

Medicare enrollment files

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 Officer Apr 16, 2018
Xuan Phan Individual Corporate Director Jan 1, 2021
Kwantrell D Green Individual Corporate Officer Apr 16, 2018
Roy a Tolbert Individual Corporate Officer Apr 16, 2018
Bertha J Oatis Individual Corporate Officer Apr 16, 2018
Paulette T Briscoe Individual Corporate Officer Apr 16, 2018
Christine M McLeod Individual Corporate Officer Apr 16, 2018
Angelique S Greer Individual W-2 Managing EmployeeCeo Apr 16, 2018
Xenia G Wickline Individual Corporate Officer Apr 16, 2018
Jane Campbell Individual Corporate Director Jan 1, 2021
Shelby Ward Individual Corporate Director Jan 1, 2021
Joseph P Hudson Individual Corporate Officer Apr 16, 2018

All facility ownership & control disclosures 6

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Coastal Family Health Center, Inc - North Bay Elementary School ClinicBay St Louis, MS, CCN 251120 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center, Inc - Bay High School ClinicBay St Louis, MS, CCN 251123 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - Waveland Elementary School ClinicWaveland, MS, CCN 251126 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - East Central Upper Elementary SchooMoss Point, MS, CCN 251125 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - Bay Waveland Middle SchoolBay St Louis, MS, CCN 251124 Federally qualified health center Operational/Managerial Control (100%) Feb 9, 2022
Coastal Family Health Center, Inc-Vancleave Upper Elementary ClinicVancleave, MS, CCN 251127 Federally qualified health center Operational/Managerial Control Nov 1, 2021

National Provider Directory

National Provider Directory
Tax ID family
Coastal Family Health Center54 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

4208 Jamestown Rd
Moss Point, MS 39563
Phone (228) 474-3300

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

4208 Jamestown Rd
Moss Point, MS 39563-9540

Mailing address

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

Other names 1

NPPES NPI Registry
  • Coastal Family Health Center, Inc - Escatawpa School Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 16, 2024.

{
    "created_epoch": "1524614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1619465705",
    "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": "228-374-2713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4208 JAMESTOWN RD",
            "city": "MOSS POINT",
            "state": "MS",
            "postal_code": "395639540",
            "telephone_number": "228-474-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-25",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "GREER",
        "authorized_official_first_name": "ANGELIQUE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "228-374-2494"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Family Health Center, Inc - Escatawpa School Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moss Point, MS

Sources for this page

Verify at the official NPI Registry.