Provider Demographics
NPI:1316403397
Name:COASTLINE MEDICALS LLC
Entity Type:Organization
Organization Name:COASTLINE MEDICALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-712-6100
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-0124
Mailing Address - Country:US
Mailing Address - Phone:207-712-6100
Mailing Address - Fax:800-380-5604
Practice Address - Street 1:530B HARKLE RD STE 100
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4739
Practice Address - Country:US
Practice Address - Phone:207-712-6100
Practice Address - Fax:800-380-5604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies