Provider Demographics
NPI:1417178815
Name:SOUTH COAST FAMILY PHYSICIANS
Entity type:Organization
Organization Name:SOUTH COAST FAMILY PHYSICIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-769-2611
Mailing Address - Street 1:3313 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39567-3228
Mailing Address - Country:US
Mailing Address - Phone:228-762-1936
Mailing Address - Fax:228-762-1936
Practice Address - Street 1:3313 MARKET ST
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-3228
Practice Address - Country:US
Practice Address - Phone:228-762-1936
Practice Address - Fax:228-762-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS=========AOtherBCBS MISSISSIPPI