Provider Demographics
NPI:1972922003
Name:AMERICOAST SPRINGFIELD LLC
Entity Type:Organization
Organization Name:AMERICOAST SPRINGFIELD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-568-2236
Mailing Address - Street 1:60 NORTHPOINTE PKWY
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1883
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3351 S 6TH STREET RD STE 8
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-4785
Practice Address - Country:US
Practice Address - Phone:217-679-2465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICOAST HOLDINGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies