Provider Demographics
NPI:1750631248
Name:COASTAL MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:COASTAL MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GERAMI
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:541-756-7715
Mailing Address - Street 1:1810 MONROE AVE STE 18
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-8521
Mailing Address - Country:US
Mailing Address - Phone:541-756-7715
Mailing Address - Fax:541-756-7716
Practice Address - Street 1:1810 MONROE AVE STE 18
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-8521
Practice Address - Country:US
Practice Address - Phone:541-756-7715
Practice Address - Fax:541-756-7716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies