Coastal Pain Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

063-355 Issued in GA

Legal business name

COASTAL PAIN CENTER, LLC

Practice address

3221 Glynn Ave
Brunswick, GA 31520-4851

Phone

(912) 466-9111

Fax

(912) 466-0366

NPI assigned

Jan 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Thomas E Runyan, M.D.

Title

Medical Director, Physician

Phone

(912) 466-9111

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Ambulatory surgical center certification: CCN 11C0001299

Legal name

COASTAL PAIN CENTER, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Jul 25, 2007

Last certification

Jun 26, 2019

Ownership / control type

Proprietary

Facility address

3221 Glynn Avenue
Brunswick, GA 31520

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Coastal Pain Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Waycross, GA
  • NPI 1114454634
  NPPES parent name

Practitioners 1

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

• Kevin Don Coyle, MB BCH BAO LRCPSI

  • Interventional Pain Medicine Physician
  • Brunswick, GA
  • NPI 1891883765
  NPD

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297641600000",
    "number": "1740336577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3221 GLYNN AVE",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204851",
            "telephone_number": "912-466-9111",
            "fax_number": "912-466-0366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3221 GLYNN AVE",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204851",
            "telephone_number": "912-466-9111",
            "fax_number": "912-466-0366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PAIN CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2011-02-14",
        "status": "A",
        "authorized_official_last_name": "RUNYAN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR, PHYSICIAN",
        "authorized_official_telephone_number": "912-466-9111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "063-355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coastal Home Care, LLC
• Coastal Hypnosis Center
• Coastal Neurology and Neurosurgery
• Coastal Nursecare Inc.
• Coastal Orthopedic Products, Inc.
• Coastal Periodontics, P.C.
• Coastal Pharmacare Inc
• Coastal Physical Therapy Inc
• Coastal Radiation Oncology Assoc.
• Coastal Ripple Effect LLC

• Ambulatory Surgical Clinic/Center in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.