Provider Demographics
NPI:1740284785
Name:WEST COAST - SOUTHERN MEDICAL SERVICE INC
Entity type:Organization
Organization Name:WEST COAST - SOUTHERN MEDICAL SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:941-748-7148
Mailing Address - Street 1:934 14TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-6646
Mailing Address - Country:US
Mailing Address - Phone:941-748-7148
Mailing Address - Fax:941-748-7265
Practice Address - Street 1:934 14TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-6646
Practice Address - Country:US
Practice Address - Phone:941-748-7148
Practice Address - Fax:941-748-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0026143416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
080288100OtherBLACK LUNG PROGRAM
FL400017005Medicaid
FL40001700Medicaid
FL400017002Medicaid
429840000OtherMAINE CARE
FL400017004Medicaid
00559OtherUNIVERSAL HEALTHCARE
590009510OtherRAILROAD MEDICARE
203246400OtherUS DEPT OF LABOR WORK COM
FL400017003Medicaid
00559OtherUNIVERSAL HEALTHCARE
FL40001700Medicaid