COASTAL FOOT CENTER (NPI# 1790943017) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790943017 |
| Entity Type | Organization |
| Organization Name | COASTAL FOOT CENTER |
| Practice Address |
217 Station St Jacksonville NC 28546-6304 |
| Practice Telephone | 9109386000 |
| Practice Fax Number | 9109383618 |
| Mailing Telephone | 9109386000 |
| Mailing Fax Number | 9109383618 |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2014-09-16 |
| Authorized Official Name | DR. VALENTINE T HAMILTON (OWNER) |
| Authorized Official Telephone | 9109386000 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
222 | NC | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE NPI TYPE1 | 261QP1100X | 01 | |
| BCBS PIN | 08055 | 01 | |
| NC | 8908055 | 05 |
| Street Address |
217 STATION ST |
| City | JACKSONVILLE |
| State | NC |
| Zip Code | 28546-6304 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982680328 | Charles Grayson Guyer | Psychologist | 217 Station St, Jacksonville, NC 28546-6304 | 2005-12-19 |
| 1558962878 | Alyse Walgren | Behavior Technician | 217 Station St, Jacksonville, NC 28546-6304 | 2020-11-03 |
| 1457968711 | Dineisha S Jones | Behavior Technician | 217 Station St, Jacksonville, NC 28546-6304 | 2020-09-29 |
| 1952918427 | Carrie Smay | Behavior Technician | 217 Station St, Jacksonville, NC 28546-6304 | 2020-09-28 |
| 1437764685 | William Joseph Wrightington Jr. | Behavior Technician | 217 Station St, Jacksonville, NC 28546-6304 | 2020-09-14 |
| 1952916173 | Chanele Tangiora | Behavior Technician | 217 Station St, Jacksonville, NC 28546-6304 | 2020-09-14 |
| 1386253771 | Jaylyn Paulino | Behavior Technician | 217 Station St, Jacksonville, NC 28546-6304 | 2020-07-30 |
| 1720602162 | Harriet Miller Hiers Lowring | Behavior Technician | 217 Station St, Jacksonville, NC 28546-6304 | 2020-06-02 |
| 1285256230 | Gabrielle Daniels | Behavior Technician | 217 Station St, Jacksonville, NC 28546-6304 | 2020-05-13 |
| 1932749603 | Elizabeth Stawicki | Behavior Technician | 217 Station St, Jacksonville, NC 28546-6304 | 2020-01-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316578388 | Judylyn Hobson | Registered Nurse | Pride In North Carolina, LLC, 3886 Henderson Dr, Jacksonville, NC 28546 | 2020-01-29 |
| 1427694637 | Aaron Patrick Bettcher | Military Health Care Provider | 3rd Mrb Loop Rd, Camp Lejeune, NC 28546 | 2019-11-22 |
| 1962044289 | Levi Scott Marshall | Military Health Care Provider | Everett Creek Road, Building 612, Camp Lejeune, NC 28546 | 2019-10-09 |
| 1649826652 | Nicholas Otazo | Military Health Care Provider | 3rd Mrb 20073, Camp Lejeune, NC 28546 | 2019-08-15 |
| 1417519570 | Publix North Carolina, Lp | Durable Medical Equipment & Medical Supplies | 2001 Marlin Drive Unit 100, Jacksonville, NC 28546 | 2019-06-28 |
| 1023500212 | Josip Ninrodriguez | Military Health Care Provider | 3d Marine Raider Battaliom, Camp Lejeune, NC 28546 | 2018-06-04 |
| 1639661192 | Kenneth Lee Russell | Military Health Care Provider | 3d Marine Raider Battalion, Camp Lejeune, NC 28546 | 2018-05-31 |
| 1346730173 | Coastal Foot Center, LLC | Clinic/Center | 29 Office Park Dr Ste B, Jacksonville, NC 28546 | 2018-05-17 |
| 1578080271 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 380 Western Blvd, Jacksonville, NC 28546 | 2017-08-24 |
| 1144757493 | Darin Lee Peterson | Specialist/Technologist | G644 Camp Geiger, School of Infantry-east, Jacksonville, NC 28546 | 2017-05-17 |
| Find all providers in zip 28546 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245751692 | Florida Foot and Ankle,inc | Podiatrist | 13241 Bartram Park Blvd Unit 1805, Jacksonville, FL 32258-5227 | 2017-07-06 |
| 1295264224 | Podiatrist On Call, LLC | Podiatrist | 2720 Park St Ste 210, Jacksonville, FL 32205-7645 | 2017-06-04 |
| 1992190524 | Richard C Harris IIi | Podiatrist | 655 W 8th St # C126, Jacksonville, FL 32209 | 2015-03-31 |
| 1497167779 | Jessica Isabel Popelka | Podiatrist | 13241 Bartram Park Blvd Unit 1809, Jacksonville, FL 32258-5227 | 2014-05-21 |
| 1417215609 | Samuel D Kulick Dpm | Podiatrist | 9397 San Jose Blvd Ste 1, Jacksonville, FL 32257-5587 | 2012-04-25 |
| 1699053819 | Troy A Harris | Podiatrist | 1560 Lancaster Ter Apt 206, Jacksonville, FL 32204-4116 | 2011-07-22 |
| 1679701429 | Lindsay Mae Chandler | Podiatrist | 655 W 8th St # C-126, Jacksonville, FL 32209-6511 | 2009-06-30 |
| 1659557239 | Foot Clinic-dr. S.f. Wernow | Podiatrist | 9397-1 San Jose Blvd, Jacksonville, FL 32257-5587 | 2008-01-14 |
| 1669692844 | Sheldon F Wernow | Podiatrist | 9397 San Jose Boulevard, Suite 1, Jacksonville, FL 32257-5587 | 2007-04-27 |
| 1144352386 | Richard I Polisner | Podiatrist | 4621 Emerson St, Jacksonville, FL 32207-4920 | 2007-03-12 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 28546 |
Please comment or provide details below to improve the information on COASTAL FOOT CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.