Provider Demographics
NPI:1871834507
Name:COASTAL CAROLINA MOBILE PHYSICIANS
Entity type:Organization
Organization Name:COASTAL CAROLINA MOBILE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BRUMFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-344-1040
Mailing Address - Street 1:1272 CROOKED OAK DR
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-8076
Mailing Address - Country:US
Mailing Address - Phone:843-344-1040
Mailing Address - Fax:843-237-9822
Practice Address - Street 1:1272 CROOKED OAK DR
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-8076
Practice Address - Country:US
Practice Address - Phone:843-344-1040
Practice Address - Fax:843-237-9822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25249207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty