Provider Demographics
NPI:1295970846
Name:COASTLINE AMBULANCE SERVICE, LLC
Entity type:Organization
Organization Name:COASTLINE AMBULANCE SERVICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:361-723-1993
Mailing Address - Street 1:PO BOX 7899
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78467-7899
Mailing Address - Country:US
Mailing Address - Phone:361-723-1993
Mailing Address - Fax:361-723-1994
Practice Address - Street 1:4455 S PADRE ISLAND DR
Practice Address - Street 2:STE 21A
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5101
Practice Address - Country:US
Practice Address - Phone:361-723-1993
Practice Address - Fax:361-723-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10002093416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199308101Medicaid
TXAMB771Medicare PIN