Provider Demographics
NPI:1235866278
Name:COASTAL AMBULANCE LLC
Entity Type:Organization
Organization Name:COASTAL AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:THEOHARIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-694-6687
Mailing Address - Street 1:372 YARMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-2043
Mailing Address - Country:US
Mailing Address - Phone:508-694-6687
Mailing Address - Fax:
Practice Address - Street 1:372 YARMOUTH RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-2043
Practice Address - Country:US
Practice Address - Phone:508-694-6687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport