Provider Demographics
NPI:1528263720
Name:COASTAL SURGICAL ASSISTANCE, INC.
Entity type:Organization
Organization Name:COASTAL SURGICAL ASSISTANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SPROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:757-831-4718
Mailing Address - Street 1:1102 WATERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3307
Mailing Address - Country:US
Mailing Address - Phone:757-831-4718
Mailing Address - Fax:
Practice Address - Street 1:1102 WATERSTONE CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3307
Practice Address - Country:US
Practice Address - Phone:757-831-4718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty