Provider Demographics
NPI:1194949248
Name:COASTAL MEDICAL SPECIALISTS IN LUNG & CRITICAL CARE, PC
Entity type:Organization
Organization Name:COASTAL MEDICAL SPECIALISTS IN LUNG & CRITICAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEWUMI
Authorized Official - Middle Name:O
Authorized Official - Last Name:OGUNTUMIBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-354-7679
Mailing Address - Street 1:411 STEPHENSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5968
Mailing Address - Country:US
Mailing Address - Phone:912-354-7679
Mailing Address - Fax:912-354-4018
Practice Address - Street 1:411 STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5968
Practice Address - Country:US
Practice Address - Phone:912-354-7679
Practice Address - Fax:912-354-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049393174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00900797HMedicaid
GA00900798CMedicaid
GA85003028GMedicaid
GA000900798IMedicaid
GA00900798GMedicaid
GA00900798HMedicaid
GA930105831OtherRAILROAD MEDICARE
GA00900798DMedicaid
GA00900798EMedicaid
GA00900798FMedicaid
GA000900798MMedicaid
GA930105831OtherRAILROAD MEDICARE
GA00900798FMedicaid