Coastal Carolina Nephrology LLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

COASTAL CAROLINA NEPHROLOGY LLC

Practice address

1938-A Charlie Hall Blvd
Charleston, SC 29414-5837

Phone

(843) 554-9313

Fax

(843) 744-5961

NPI assigned

Nov 7, 2005

Reactivated

Aug 29, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Lisa R Stewart, MD

Title

Partner

Phone

(843) 554-9313

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Trident Nephrology LLC Former legal business name

Locations

Practitioners 1

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

• Charles Jerry Owens, MD

  • Nephrology Physician
  • Charleston, SC
  • NPI 1265494884

  Nephrology

  NPD (past)

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188345600000",
    "number": "1679554752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1938-A CHARLIE HALL BLVD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145837",
            "telephone_number": "843-554-9313",
            "fax_number": "843-744-5961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1938-A CHARLIE HALL BLVD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145837",
            "telephone_number": "843-554-9313",
            "fax_number": "843-744-5961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA NEPHROLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-07",
        "last_updated": "2007-08-29",
        "deactivation_date": "2006-03-03",
        "reactivation_date": "2007-08-29",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "843-554-9313",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "8172",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP",
            "identifier": "GP2967",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trident Nephrology LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Ernest B Clyburn, MD
• Coafs Lab
• Coast Dialysis LLC
• Coastal Anesthesia Associates, LLC
• Coastal Cardiology, P.a.
• Coastal Carolina Rehabilitation, LLC
• Coastal Eye Care of Charleston, LLC
• Coastal Eye Care of Daniel Island
• Coastal Eye Care of James Island
• Coastal Family Dentistry of West Ashley, PA

• All providers in Charleston, SC
• Nephrology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2007; 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.