Provider Demographics
NPI:1871758284
Name:COASTAL FLORIDA HOSPITALIST PL
Entity type:Organization
Organization Name:COASTAL FLORIDA HOSPITALIST PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIDI
Authorized Official - Middle Name:U
Authorized Official - Last Name:UCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-651-0323
Mailing Address - Street 1:683 CANDLEBARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-5361
Mailing Address - Country:US
Mailing Address - Phone:832-651-0323
Mailing Address - Fax:
Practice Address - Street 1:4201 BELFORT RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1431
Practice Address - Country:US
Practice Address - Phone:832-651-0323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97989208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty