Provider Demographics
NPI:1326825308
Name:CENTRAL COAST MD MEDICAL SUPPLIES AND UNIFORMS
Entity Type:Organization
Organization Name:CENTRAL COAST MD MEDICAL SUPPLIES AND UNIFORMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-588-7767
Mailing Address - Street 1:1840 41ST AVE STE 102-259
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2513
Mailing Address - Country:US
Mailing Address - Phone:831-588-7767
Mailing Address - Fax:
Practice Address - Street 1:901 SUNSET DR STE 4
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5613
Practice Address - Country:US
Practice Address - Phone:831-588-7767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health
No332900000XSuppliersNon-Pharmacy Dispensing Site