Provider Demographics
NPI:1134155575
Name:COASTAL AMBULANCE CO.,INC
Entity type:Organization
Organization Name:COASTAL AMBULANCE CO.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:H.STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIDGEN
Authorized Official - Suffix:
Authorized Official - Credentials:TEACHER,PARAMEDIC
Authorized Official - Phone:910-324-6304
Mailing Address - Street 1:194 THOMAS LOOP RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-8518
Mailing Address - Country:US
Mailing Address - Phone:910-324-6304
Mailing Address - Fax:910-324-3040
Practice Address - Street 1:194 THOMAS LOOP RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-8518
Practice Address - Country:US
Practice Address - Phone:910-324-6304
Practice Address - Fax:910-324-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0520902146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406781Medicaid
NC2782056Medicare ID - Type Unspecified