Coastal Wound Care, LLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

COASTAL WOUND CARE, LLC

Practice address

2060 Charlie Hall Blvd Ste a
Charleston, SC 29414-6066

Phone

(843) 483-0193

Fax

(839) 213-4599

NPI assigned

Jun 8, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Timothy James Durkan Gregory, MDNPI 1073556452

Title

Physician/Owner

Phone

(254) 368-7864

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 3

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

• Timothy James Durkan Gregory, MD

  • Emergency Medicine Physician
  • Charleston, SC
  • NPI 1073556452
  Medicare reassignment Care Compare group NPD Authorized official
• Lisa Covell, APRN

  • Nurse Practitioner
  • Charleston, SC
  • NPI 1437826716
  Medicare reassignment Care Compare group NPD
• Anne Louise Edwards, MD

  • Plastic Surgery Physician
  • Charleston, SC
  • NPI 1942258561
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1686182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729468800000",
    "number": "1811681018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2060 CHARLIE HALL BLVD STE A",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294146066",
            "telephone_number": "843-483-0193",
            "fax_number": "839-213-4599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 CHARLIE HALL BLVD STE A",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294146066",
            "telephone_number": "843-483-0193",
            "fax_number": "839-213-4599"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5401 Netherby Ln Ste 301",
            "address_purpose": "LOCATION",
            "city": "North Charleston",
            "state": "SC",
            "postal_code": "294207364",
            "country_code": "US",
            "telephone_number": "843-483-0193",
            "fax_number": "839-213-4599",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COASTAL WOUND CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-08",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A",
        "authorized_official_last_name": "GREGORY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JAMES DURKAN",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "254-368-7864",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331297",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Coastal Pediatric Associates, P.a.
• Coastal Play 2 Grow Therapy, LLC
• Coastal Psychiatry, LLC
• Coastal Pulmonary, LLP
• Coastal Vascular & Vein Center, LLC
• William Jonas Coatsworth, MA, LPC, LAC, CAC-II
• Lamor Coaxum
• Tiffany Samantha Coaxum
• Jasmine N Cobb
• Kristen Marie Cobb, RN

• Emergency Medicine Physician in Charleston, SC
• Providers in Charleston, SC by specialty
• Emergency Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.