Provider Demographics
NPI:1841154150
Name:COASTAL DME, LLC
Entity type:Organization
Organization Name:COASTAL DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-481-1117
Mailing Address - Street 1:7113 LAGOON DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-5509
Mailing Address - Country:US
Mailing Address - Phone:850-481-1117
Mailing Address - Fax:850-373-4858
Practice Address - Street 1:231 SOUTHWOOD DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4905
Practice Address - Country:US
Practice Address - Phone:850-481-1117
Practice Address - Fax:850-373-4858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-11
Last Update Date:2025-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies