Provider Demographics
NPI:1386989028
Name:COASTAL CAROLINA ENT, DO, PA
Entity type:Organization
Organization Name:COASTAL CAROLINA ENT, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE/BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PARIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:910-914-0540
Mailing Address - Street 1:302 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3714
Mailing Address - Country:US
Mailing Address - Phone:910-914-0540
Mailing Address - Fax:910-914-0640
Practice Address - Street 1:3806 SAWTELL RD
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-7873
Practice Address - Country:US
Practice Address - Phone:843-663-9090
Practice Address - Fax:843-663-9091
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL CAROLINA ENT, DO, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-06
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDO 1480207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1689757007OtherNC NPI
SC1386989028OtherNPI