Provider Demographics
NPI:1437249216
Name:MEDCOAST MEDSERVICES, INC.
Entity Type:Organization
Organization Name:MEDCOAST MEDSERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LAURIE
Authorized Official - Last Name:TWADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-926-9990
Mailing Address - Street 1:PO BOX 2029
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-4029
Mailing Address - Country:US
Mailing Address - Phone:888-241-2043
Mailing Address - Fax:253-853-1338
Practice Address - Street 1:14325 ISELI RD
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-5203
Practice Address - Country:US
Practice Address - Phone:526-926-9990
Practice Address - Fax:562-926-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18503416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE01130FMedicaid
CAZ533Medicare ID - Type Unspecified
CAMTE01130FMedicaid