Provider Demographics
NPI:1093868309
Name:COASTAL CAROLINA RESPIRATORY SERVICES
Entity type:Organization
Organization Name:COASTAL CAROLINA RESPIRATORY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:RRT, RCP, AE-C
Authorized Official - Phone:919-920-8916
Mailing Address - Street 1:106 S. BROWN ROAD
Mailing Address - Street 2:PO BOX 467
Mailing Address - City:BEULAVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28518-0467
Mailing Address - Country:US
Mailing Address - Phone:919-920-8916
Mailing Address - Fax:
Practice Address - Street 1:106 S. BROWN ROAD
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518-0467
Practice Address - Country:US
Practice Address - Phone:919-920-8916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA407227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Multi-Specialty