Provider Demographics
NPI:1104563352
Name:COASTAL ASC,LLC
Entity type:Organization
Organization Name:COASTAL ASC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FIX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-562-0018
Mailing Address - Street 1:188 W NORTHERN LIGHTS BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3902
Mailing Address - Country:US
Mailing Address - Phone:907-562-0018
Mailing Address - Fax:907-562-0019
Practice Address - Street 1:188 W NORTHERN LIGHTS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3902
Practice Address - Country:US
Practice Address - Phone:907-562-0018
Practice Address - Fax:907-562-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical