Provider Demographics
NPI:1114055407
Name:COASTAL MED TECH, INC.
Entity Type:Organization
Organization Name:COASTAL MED TECH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-848-7152
Mailing Address - Street 1:730 CENTER STREET, UNIT 10-C
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210
Mailing Address - Country:US
Mailing Address - Phone:207-782-0660
Mailing Address - Fax:207-782-0441
Practice Address - Street 1:730 CENTER ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6316
Practice Address - Country:US
Practice Address - Phone:207-782-0660
Practice Address - Fax:207-782-0441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL MED TECH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-01
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1142509332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME118860000Medicaid
ME0481350003Medicare NSC