NPIMap

Organization Active NPI

Coastal Vascular and Interventional PLLC

  • Vascular Surgery Physician
  • Niceville, FL
National Provider Identifier
1851960793
Registry record updated Jun 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
COASTAL VASCULAR AND INTERVENTIONAL PLLC
Practice address
4585 E Highway 20 Ste 125
Niceville, FL 32578-7709
Phone
(850) 479-1805
Fax
(850) 479-1859
NPI assigned
Jun 24, 2021
Last updated
Jun 24, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2021

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

Authorized official

Name
Danelle Fischer
Title
Administrator
Phone
(850) 479-1805

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU
Vascular & Interventional Radiology Physician 2085R0204X NU
Vascular Surgery Physician 2086S0129X NU Primary

Addresses

Primary practice location

4585 E Highway 20 Ste 125
Niceville, FL 32578-7709

Mailing address

PO Box 11982
Pensacola, FL 32524-1982
Phone (850) 479-1805

National Provider Directory

National Provider Directory
Tax ID family
Coastal Vascular and Interventional PLLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4585 E Highway 20
Ste 125
Niceville, FL 32578
Phone (850) 426-5191

NPI Registry JSON

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

{
    "created_epoch": "1624492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624492800000",
    "number": "1851960793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11982",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325241982",
            "telephone_number": "850-479-1805",
            "fax_number": "850-479-1829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4585 E HIGHWAY 20 STE 125",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325787709",
            "telephone_number": "850-479-1805",
            "fax_number": "850-479-1859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL VASCULAR AND INTERVENTIONAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-24",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A",
        "authorized_official_last_name": "FISCHER",
        "authorized_official_first_name": "DANELLE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "850-479-1805"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niceville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2021; 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.