Provider Demographics
NPI:1245252857
Name:COASTAL MEDICAL SUPPLY COMPANY
Entity type:Organization
Organization Name:COASTAL MEDICAL SUPPLY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:UDOCHUKWU
Authorized Official - Last Name:OJIMADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-232-5270
Mailing Address - Street 1:3214 CHARLES B ROOT WYND STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5440
Mailing Address - Country:US
Mailing Address - Phone:919-881-0279
Mailing Address - Fax:919-881-0279
Practice Address - Street 1:3214 CHARLES B ROOT WYND STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5440
Practice Address - Country:US
Practice Address - Phone:919-881-0279
Practice Address - Fax:919-881-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5140940001Medicare NSC