Provider Demographics
NPI:1326219502
Name:COASTAL MEDICAL SUPPLY & EQUIPMENT INC
Entity Type:Organization
Organization Name:COASTAL MEDICAL SUPPLY & EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:NATAL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:228-467-5567
Mailing Address - Street 1:315 HWY 90
Mailing Address - Street 2:SUITE I
Mailing Address - City:WAVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39576-2624
Mailing Address - Country:US
Mailing Address - Phone:228-467-5567
Mailing Address - Fax:228-467-5568
Practice Address - Street 1:315 HIGHWAY 90
Practice Address - Street 2:SUITE I
Practice Address - City:WAVELAND
Practice Address - State:MS
Practice Address - Zip Code:39576-2624
Practice Address - Country:US
Practice Address - Phone:228-467-5567
Practice Address - Fax:228-467-5568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2155332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS6070250001Medicare NSC