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Provider Information for 1740212174



COASTAL NEUROLOGICAL INSTITUTE P.C.

Organization Subpart: NO

Organization NPI: 1740212174

Calendar Last Updated: 2007-07-08

Details

Name Value
NPI 1740212174
Enumeration Date 2006-07-07
NPI Type 2- Organization
Status Active
Authorized Official Information Name: DR. WILLIAM B FAIRCLOTH M.D.
Title: PRESIDENT
Phone: 251-450-3700
Mailing Address 3280 DAUPHIN ST SUITE A
MOBILE, AL 36606-4060
United States

Phone: 251-450-3700 | Fax: 251-662-3819
View Map External Link
Primary Practice Address 3280 DAUPHIN ST SUITE A
MOBILE, AL 36606-4060
United States

Phone: 251-450-3700 | Fax: 251-662-3819
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
No 193200000X MULTI-SPECIALTY GROUP
207T00000X - Neurological Surgery
AL 16395
No 193200000X MULTI-SPECIALTY GROUP
2081P2900X - Physical Medicine & Rehabilitation Pain Medicine
AL 20439