Provider Demographics
NPI:1770047946
Name:COASTAL MEDICAL, LLC
Entity type:Organization
Organization Name:COASTAL MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-980-0774
Mailing Address - Street 1:PO BOX 2894
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36547-2894
Mailing Address - Country:US
Mailing Address - Phone:251-978-0774
Mailing Address - Fax:855-766-4632
Practice Address - Street 1:4851 WHARF PKWY STE D216-F
Practice Address - Street 2:
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561-5873
Practice Address - Country:US
Practice Address - Phone:251-980-0774
Practice Address - Fax:833-270-1634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies