Provider Demographics
NPI:1881652162
Name:COASTAL MED-TECH CORP.
Entity Type:Organization
Organization Name:COASTAL MED-TECH CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-441-8876
Mailing Address - Street 1:25 DOUGLAS HWY
Mailing Address - Street 2:
Mailing Address - City:LAMOINE
Mailing Address - State:ME
Mailing Address - Zip Code:04605-2522
Mailing Address - Country:US
Mailing Address - Phone:207-677-2508
Mailing Address - Fax:207-667-3099
Practice Address - Street 1:25 DOUGLAS HWY
Practice Address - Street 2:
Practice Address - City:LAMOINE
Practice Address - State:ME
Practice Address - Zip Code:04605-2522
Practice Address - Country:US
Practice Address - Phone:207-677-2508
Practice Address - Fax:207-667-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME131150000Medicaid
ME1221420001Medicare NSC