Coastal Cardiology, PC

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

18035 Issued in MS

Legal business name

COASTAL CARDIOLOGY, PC

Practice address

4211 Hospital St
Suite 107
Pascagoula, MS 39581-5310

Phone

(228) 202-3335

Fax

(228) 202-3337

NPI assigned

Dec 11, 2006

Organization subpart

No

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

Authorized official

Name

Pavel Khimenko, MD

Title

President

Phone

(228) 202-3335

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326758400000",
    "number": "1639239387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 HOSPITAL ST",
            "address_2": "SUITE 107",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815310",
            "telephone_number": "228-202-3335",
            "fax_number": "228-202-3337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4211 HOSPITAL ST",
            "address_2": "SUITE 107",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815310",
            "telephone_number": "228-202-3335",
            "fax_number": "228-202-3337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CARDIOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2012-01-17",
        "status": "A",
        "authorized_official_last_name": "KHIMENKO",
        "authorized_official_first_name": "PAVEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "228-202-3335",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MS",
            "license": "18035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00571214",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "422390786C",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• CLC of Pascagoula, LLC
• Chelsea Jones Clements, PHARMD
• Brandon S Cloud, PT
• Coast Chiropractic P.a.
• Coast to Coast Rehab LLC
• Cochran Counseling Services LLC
• Gina Cochran, LPC
• Melissa Ruth Cochran, WHNP
• Joshua Coker, M.D.
• Devon Elijah Coleman, DMD

• All providers in Pascagoula, MS
• Cardiovascular Disease Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2012; 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.