Provider Demographics
NPI:1508524406
Name:COASTAL MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:COASTAL MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-206-5211
Mailing Address - Street 1:10585 THREE RIVERS RD STE F
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3572
Mailing Address - Country:US
Mailing Address - Phone:228-206-5211
Mailing Address - Fax:228-206-4993
Practice Address - Street 1:10585 THREE RIVERS RD STE F
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3572
Practice Address - Country:US
Practice Address - Phone:601-701-3438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies