Provider Demographics
NPI:1346913530
Name:NORTH COAST MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:NORTH COAST MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:CADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-579-7201
Mailing Address - Street 1:PO BOX 9041
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92018-9041
Mailing Address - Country:US
Mailing Address - Phone:800-730-9887
Mailing Address - Fax:800-503-6280
Practice Address - Street 1:2544 CAMPBELL PL STE 150
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-1768
Practice Address - Country:US
Practice Address - Phone:800-730-9887
Practice Address - Fax:800-503-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5601690OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA466150Medicaid