Coastal Carolina Surgical Assoc

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

Legal business name

COASTAL CAROLINA SURGICAL ASSOC

Practice address

1055 Ribaut Road
Suite 30
Beaufort, SC 29902-5447

Phone

(843) 524-8171

Fax

(843) 525-6613

NPI assigned

Dec 18, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Lori Noel Mock

Title

Practice Administrator

Phone

(843) 524-8171

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1831252477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 RIBAUT ROAD",
            "address_2": "SUITE 30",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025447",
            "telephone_number": "843-524-8171",
            "fax_number": "843-525-6613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 RIBAUT ROAD",
            "address_2": "SUITE 30",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025447",
            "telephone_number": "843-524-8171",
            "fax_number": "843-525-6613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA SURGICAL ASSOC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "MOCK",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "NOEL",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "843-524-8171",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel Jason Clark, PHYSICIAN ASSISTANT
• Barbara A. Clarke, LICENSED PSYCHOLOGIS
• Marsha Elizabeth Clyburn, RDH
• Coastal Cardiovascular Clinic
• Coastal Caremd
• Coastal Carolina Urology Group LLC
• Coastal Carolina Urology Group, LLC
• Coastal Empire
• Coastal Empire Community Mental Health Center
• Coastal Hand Therapy Inc

• Vascular Surgery Physician in Beaufort, SC
• Providers in Beaufort, SC by specialty
• Vascular Surgery Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.