Provider Demographics
NPI:1659688752
Name:COASTAL MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:COASTAL MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHEZAD
Authorized Official - Middle Name:ABDULLAH
Authorized Official - Last Name:MOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-254-0887
Mailing Address - Street 1:282 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-3322
Mailing Address - Country:US
Mailing Address - Phone:561-254-0887
Mailing Address - Fax:
Practice Address - Street 1:282 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-3322
Practice Address - Country:US
Practice Address - Phone:561-254-0887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment