Provider Demographics
NPI:1295468577
Name:COASTAL DIAGNOSTIC LLC
Entity Type:Organization
Organization Name:COASTAL DIAGNOSTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GERAMI
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:541-982-5040
Mailing Address - Street 1:2225 NW STEWART PKWY
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1650
Mailing Address - Country:US
Mailing Address - Phone:458-803-0999
Mailing Address - Fax:458-803-0900
Practice Address - Street 1:2225 NW STEWART PKWY
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1650
Practice Address - Country:US
Practice Address - Phone:458-803-0999
Practice Address - Fax:458-803-0900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL DIAGNOSTIC TESTING GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic