Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Intracoastal Executive Wellness

Organization Internal Medicine Physician · NPI 1013760172

Intracoastal Executive Wellness is an Internal Medicine Physician in Southport, North Carolina. Registered with an NPI since 2024.

In the registry since
2024

Practice location Address checks out

606 W West St Ste 202
Southport, NC 28461-3850
Phone: (910) 286-7420
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X

Record details

NPI number1013760172
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Richard Hilliard — Member · (910) 286-7420
NPI enumeratedApril 9, 2024
Last updated in NPPESApril 9, 2024
Certification dateApril 9, 2024
Mailing address606 W West St Ste 202, Southport, NC 28461-3850

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