| Coastal Family Practice Pc | |
|
2109 Mccomas Way Suite 102 Virginia Beach VA 23456-3909 | |
| (757) 563-2800 | |
| Not Available |
| Full Name | Coastal Family Practice Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2109 Mccomas Way, Virginia Beach, Virginia |
| Authorized Official Name and Position | Mitchell B Miller (PRESIDENT) |
| Authorized Official Contact | 7575632800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Family Practice Pc 2109 Mccomas Way Suite 102 Virginia Beach VA 23456-3909 Ph: (757) 563-2800 | Coastal Family Practice Pc 2109 Mccomas Way Suite 102 Virginia Beach VA 23456-3909 Ph: (757) 563-2800 |
| NPI Number | 1295893097 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 01/30/2009 |
| Medicare PECOS PAC ID | 6305908716 |
|---|---|
| Medicare Enrollment ID | O20081218000590 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295893097 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 0101032190 (Virginia) | Primary |
| Provider Name | Mitchell B Miller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902809437 PECOS PAC ID: 5395717706 Enrollment ID: I20040806000944 |
| Provider Name | Michele L Porter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669776803 PECOS PAC ID: 8325217516 Enrollment ID: I20110804000042 |
| Provider Name | Juli M Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699165910 PECOS PAC ID: 8820315286 Enrollment ID: I20150323002476 |
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