NPIMap

Organization Active NPI

Coastal Preventative Medicine, LLC

  • Primary Care Clinic/Center
  • Gautier, MS
National Provider Identifier
1699067959
Registry record updated May 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
COASTAL PREVENTATIVE MEDICINE, LLC
Practice address
3300 Ladnier Rd
Gautier, MS 39553-5909
Phone
(228) 497-2652
Fax
(228) 497-3667
NPI assigned
May 4, 2011
Last updated
May 4, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2011

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

Authorized official

Name
Mr. Barry Monday
Title
Admin
Phone
(601) 296-2552

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X MS
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

3300 Ladnier Rd
Gautier, MS 39553-5909

Mailing address

PO Box 17708
Hattiesburg, MS 39404-7708
Phone (601) 296-2552

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1304467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304467200000",
    "number": "1699067959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17708",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394047708",
            "telephone_number": "601-296-2552",
            "fax_number": "601-296-2397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 LADNIER RD",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "395535909",
            "telephone_number": "228-497-2652",
            "fax_number": "228-497-3667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PREVENTATIVE MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-04",
        "last_updated": "2011-05-04",
        "status": "A",
        "authorized_official_last_name": "MONDAY",
        "authorized_official_first_name": "BARRY",
        "authorized_official_title_or_position": "ADMIN",
        "authorized_official_telephone_number": "601-296-2552",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MS",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gautier, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2011; 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.