Provider Demographics
NPI:1336377969
Name:ONE COAST MEDICAL, INC
Entity Type:Organization
Organization Name:ONE COAST MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MONTE
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:251-675-3633
Mailing Address - Street 1:403B HIGHWAY 43 S
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-2812
Mailing Address - Country:US
Mailing Address - Phone:251-675-3633
Mailing Address - Fax:251-675-3303
Practice Address - Street 1:403B HIGHWAY 43 S
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-2812
Practice Address - Country:US
Practice Address - Phone:251-675-3633
Practice Address - Fax:251-675-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies