Provider Demographics
NPI:1992937528
Name:COASTAL PRACTICE MANAGEMENT LLC
Entity type:Organization
Organization Name:COASTAL PRACTICE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-302-0215
Mailing Address - Street 1:4949 E STATE ROAD 64
Mailing Address - Street 2:#142
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5530
Mailing Address - Country:US
Mailing Address - Phone:941-302-0215
Mailing Address - Fax:
Practice Address - Street 1:4949 E STATE ROAD 64
Practice Address - Street 2:#142
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5530
Practice Address - Country:US
Practice Address - Phone:941-302-0215
Practice Address - Fax:941-896-6531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-16
Last Update Date:2009-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management