Provider Demographics
NPI:1851613087
Name:COASTAL ORTHOTICS AND PROSTHETICS LLC
Entity Type:Organization
Organization Name:COASTAL ORTHOTICS AND PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:NORTHEY
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:985-345-9940
Mailing Address - Street 1:1100 C.M. FAGAN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403
Mailing Address - Country:US
Mailing Address - Phone:985-345-9940
Mailing Address - Fax:985-345-9941
Practice Address - Street 1:1100 C M FAGAN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5963
Practice Address - Country:US
Practice Address - Phone:985-345-9940
Practice Address - Fax:985-345-9941
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL ORTHOTICS AND PROSTHETICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-15
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4486360002Medicare NSC