Provider Demographics
NPI:1457828253
Name:COASTAL COMPREHENSIVE CARE PA
Entity type:Organization
Organization Name:COASTAL COMPREHENSIVE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:910-663-2273
Mailing Address - Street 1:PO BOX 2123
Mailing Address - Street 2:
Mailing Address - City:BRYSON CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28713-5123
Mailing Address - Country:US
Mailing Address - Phone:910-490-0490
Mailing Address - Fax:828-538-4441
Practice Address - Street 1:710 SUNSET BLVD N STE A
Practice Address - Street 2:
Practice Address - City:SUNSET BEACH
Practice Address - State:NC
Practice Address - Zip Code:28468-4340
Practice Address - Country:US
Practice Address - Phone:910-663-2273
Practice Address - Fax:910-663-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCEC2848OtherRAILROAD MEDICARE
NC02EYBOtherBCBS NC
NC1457828253Medicaid
NCI564OtherMEDICARE