Provider Demographics
NPI:1013284603
Name:COASTAL AMBULANCE LLC
Entity Type:Organization
Organization Name:COASTAL AMBULANCE LLC
Other - Org Name:COASTAL AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VLASTIMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMETKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-935-5525
Mailing Address - Street 1:478 CESSNA AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-2245
Mailing Address - Country:US
Mailing Address - Phone:404-695-8420
Mailing Address - Fax:864-643-2485
Practice Address - Street 1:415 ROBERTSON BLVD STE B
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-5713
Practice Address - Country:US
Practice Address - Phone:888-935-5525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-26
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2953416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport