Provider Demographics
NPI:1306027347
Name:COASTAL MEDICAL SERVICES AND STAFFING
Entity Type:Organization
Organization Name:COASTAL MEDICAL SERVICES AND STAFFING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORNELIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKENAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-541-1667
Mailing Address - Street 1:9888 BISSONNET ST STE 410
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8297
Mailing Address - Country:US
Mailing Address - Phone:713-541-1667
Mailing Address - Fax:713-541-2669
Practice Address - Street 1:9888 BISSONNET ST STE 410
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8297
Practice Address - Country:US
Practice Address - Phone:713-541-1667
Practice Address - Fax:713-541-2669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155599701Medicaid
TX155599702Medicaid
4579710001Medicare NSC