Provider Demographics
NPI:1932102118
Name:COASTAL MED TECH INC
Entity Type:Organization
Organization Name:COASTAL MED TECH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SEVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-848-7152
Mailing Address - Street 1:25 DOUGLAS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605
Mailing Address - Country:US
Mailing Address - Phone:207-667-2508
Mailing Address - Fax:207-667-3099
Practice Address - Street 1:25 DOUGLAS HWY
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-0791
Practice Address - Country:US
Practice Address - Phone:800-544-1113
Practice Address - Fax:207-667-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME227424332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME118860000Medicaid
ME118860000Medicaid