Provider Demographics
NPI:1952637936
Name:COASTAL MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:COASTAL MEDICAL SUPPLY, INC.
Other - Org Name:COASTAL MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SEINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-545-2500
Mailing Address - Street 1:74 N PECOS RD STE D
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7344
Mailing Address - Country:US
Mailing Address - Phone:808-545-2500
Mailing Address - Fax:808-545-2551
Practice Address - Street 1:560 N NIMITZ HWY STE 115B
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5380
Practice Address - Country:US
Practice Address - Phone:808-545-2500
Practice Address - Fax:808-545-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI6387270001Medicare NSC