NPIMap

Organization Active NPI

Coastal Care Medical Center Inc

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1902970684
Registry record updated Jan 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COASTAL CARE MEDICAL CENTER INC
Practice address
11761 Beach Blvd
Suite 8
Jacksonville, FL 32246-6615
Phone
(904) 642-3304
Fax
(904) 928-3561
NPI assigned
Nov 17, 2006
Last updated
Jan 6, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2016

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

Authorized official

Name
Dr. Clint D Miller, DCNPI 1467403824
Title
President
Phone
(904) 642-3304

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

11761 Beach Blvd
Suite 8
Jacksonville, FL 32246-6615

Mailing address

11761 Beach Blvd
Suite 8
Jacksonville, FL 32246-6615
Phone (904) 642-3304

Other names 1

  • Coastal Care Medical Center Former legal business name

National Provider Directory

National Provider Directory

Locations

10909 Atlantic Blvd
Ste 9
Jacksonville, FL 32225
Phone (904) 642-3304

Practitioners & affiliated clinicians

Practitioners 9

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": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452038400000",
    "number": "1902970684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11761 BEACH BLVD",
            "address_2": "SUITE 8",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322466615",
            "telephone_number": "904-642-3304",
            "fax_number": "904-928-3561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11761 BEACH BLVD",
            "address_2": "SUITE 8",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322466615",
            "telephone_number": "904-642-3304",
            "fax_number": "904-928-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CARE MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2016-01-06",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "CLINT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-642-3304",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Care Medical Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; 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.