Coastal Vascular And Interventional PLLC
in Fort Walton Beach, FL. Organization (NPI-2).
NPI number1164091005
StatusActive
Last updated in NPPESJun 24, 2021
Details
- NPI
- 1164091005
- Entity type
- Organization (NPI-2)
- Legal business name
- Coastal Vascular And Interventional PLLC
- Organization subpart
- No
- Enumeration date
- Jun 24, 2021
- Certification date
- Jun 24, 2021
- Last updated
- Jun 24, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2086S0129X | – | – | Yes | |
| 2085R0202X | Radiology, Diagnostic Radiology | – | – | |
| 2085R0204X | Radiology, Vascular & Interventional Radiology | – | – |
Practice location
1032 Mar Walt Dr Unit 250Fort Walton Beach, FL 32547-6663
Phone 850-479-1805 · Fax 850-479-1829
Mailing address
Po Box 11982Pensacola, FL 32524-1982
Phone 850-479-1805 · Fax 850-479-1829
Authorized official
Danelle Fischer
Administrator
8504791805
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