Provider Demographics
NPI:1922254457
Name:COASTAL ACCESS INC
Entity Type:Organization
Organization Name:COASTAL ACCESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-661-9227
Mailing Address - Street 1:3011 HIGHWAY 30 W # 101-166
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-3534
Mailing Address - Country:US
Mailing Address - Phone:936-581-5356
Mailing Address - Fax:866-249-9163
Practice Address - Street 1:3011 HIGHWAY 30 W # 101-166
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-3534
Practice Address - Country:US
Practice Address - Phone:936-581-5356
Practice Address - Fax:866-249-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176786155OtherDUNS
TX332B00000XOtherMEMBER TAXONOMY
TX2248OtherTRCC
TXBNTCS0189Medicaid
S500292970OtherUNKNOWN
TX171WH0202XOtherMEMBER TAXONOMY