NPIMap

Organization Active NPI

Coastal Family Health Center, Inc

Doing business as Coastal Family Health Center, Inc - Lucedale Clinic

  • Federally Qualified Health Center (FQHC)
  • Lucedale, MS
National Provider Identifier
1861950982
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COASTAL FAMILY HEALTH CENTER, INC
Doing business as
Coastal Family Health Center, Inc - Lucedale Clinic
Practice address
11231 Old 63 S
Lucedale, MS 39452-4941
Phone
(228) 374-2494
NPI assigned
Mar 7, 2019
Last updated
Aug 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Authorized official

Name
Angelique Greer
Title
Ceo
Phone
(228) 374-2494

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

11231 Old 63 S
Lucedale, MS 39452-4941

Mailing address

10467 Corporate Dr
Gulfport, MS 39503-4634
Phone (228) 374-2494

Other names 1

  • Coastal Family Health Center, Inc - Lucedale Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040108000698 MS Part B Supplier - Clinic/Group Practice 8628989654 Receives reassigned benefits from 90 practitioners
37 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: MC Lain, MS; Moss Point, MS; Ocean Springs, MS; Pass Christian, MS; Richton, MS; State Line, MS; Vancleave, MS; Waveland, MS…
O20190321002192 MS Part A Provider - Federally Qualified Health Center (FQHC) 8628989654 Practice locations: Lucedale, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861950982. Details of each certification follow.

Federally qualified health center certification: CCN 251087

Legal name
COASTAL FAMILY HEALTH CENTER, INC
Doing business as
COASTAL FAMILY HEALTH CENTER, INC - LUCEDALE CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 14, 2019
Last certification
Mar 14, 2019
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Aug 25, 1978 in MS
Enrollment address
11231 Old 63 S
Lucedale, MS 39452-4941

Other NPIs on the same Medicare enrollment 37

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 37

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2166207Coastal Family Health Center Lucedale11231 Old 63 South Suite C-1, Lucedale, MS 39452Provider-performed microscopyMay 13, 2027

National Provider Directory

National Provider Directory
Tax ID family
Coastal Family Health Center54 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

Locations

11231 Old 63 S
Lucedale, MS 39452

11231 Old 63 S
Ste C1
Lucedale, MS 39452

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Judy a Grant Individual Corporate Director Mar 6, 2019
Xuan Phan Individual Corporate Director Jan 1, 2021
Kwantrell D Green Individual Corporate Director Mar 6, 2019
Roy a Tolbert Individual Corporate Director Mar 6, 2019
Bertha J Oatis Individual Corporate Director Mar 6, 2019
Paulette T Briscoe Individual Corporate Director Mar 6, 2019
Christine M McLeod Individual Corporate Director Mar 6, 2019
Angelique S Greer Individual Corporate Director Mar 6, 2019
W-2 Managing EmployeeCeo Mar 6, 2019
Xenia G Wickline Individual Corporate Director Mar 6, 2019
Jane Campbell Individual Corporate Director Mar 6, 2019
Shelby Ward Individual Corporate Director Mar 6, 2019
Joseph P Hudson Individual Corporate Director Mar 6, 2019

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Coastal Family Health Center, Inc - North Bay Elementary School ClinicBay St Louis, MS, CCN 251120 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center, Inc - Bay High School ClinicBay St Louis, MS, CCN 251123 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - Waveland Elementary School ClinicWaveland, MS, CCN 251126 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - East Central Upper Elementary SchooMoss Point, MS, CCN 251125 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - Bay Waveland Middle SchoolBay St Louis, MS, CCN 251124 Federally qualified health center Operational/Managerial Control (100%) Feb 9, 2022
Coastal Family Health Center, Inc-Vancleave Upper Elementary ClinicVancleave, MS, CCN 251127 Federally qualified health center Operational/Managerial Control Nov 1, 2021

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1551916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1861950982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10467 CORPORATE DR",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034634",
            "telephone_number": "228-374-2494",
            "fax_number": "228-374-2713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11231 OLD 63 S",
            "city": "LUCEDALE",
            "state": "MS",
            "postal_code": "394524941",
            "telephone_number": "228-374-2494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-07",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "GREER",
        "authorized_official_first_name": "ANGELIQUE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "228-374-2494"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Family Health Center, Inc - Lucedale Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lucedale, MS

Sources for this page

Verify at the official NPI Registry.