Provider Demographics
NPI:1558302414
Name:COASTAL MEDICAL SERVICES DME & SUPPLY, INC
Entity Type:Organization
Organization Name:COASTAL MEDICAL SERVICES DME & SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IMEH
Authorized Official - Middle Name:
Authorized Official - Last Name:OKPON-JACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-980-2057
Mailing Address - Street 1:13004 MURPHY RD
Mailing Address - Street 2:218
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3971
Mailing Address - Country:US
Mailing Address - Phone:281-980-2057
Mailing Address - Fax:281-980-2067
Practice Address - Street 1:13004 MURPHY RD
Practice Address - Street 2:SUITE 218
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3971
Practice Address - Country:US
Practice Address - Phone:281-980-2057
Practice Address - Fax:281-980-2067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0068682332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies