Provider Demographics
NPI:1578674214
Name:COASTAL WOMEN'S HEALTHCARE
Entity type:Organization
Organization Name:COASTAL WOMEN'S HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEV
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEUGEBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-885-8422
Mailing Address - Street 1:71 US ROUTE ONE
Mailing Address - Street 2:SUITE A, ELEVATION CENTER
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9375
Mailing Address - Country:US
Mailing Address - Phone:207-885-8400
Mailing Address - Fax:207-885-8499
Practice Address - Street 1:71 US ROUTE ONE
Practice Address - Street 2:SUITE A, ELEVATION CENTER
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9375
Practice Address - Country:US
Practice Address - Phone:207-885-8400
Practice Address - Fax:207-885-8499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECOMM3151Medicare ID - Type Unspecified