1912475609 NPI number — COASTAL MED-TECH CORP.

Table of content: (NPI 1912475609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912475609 NPI number — COASTAL MED-TECH CORP.

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
COASTAL MED-TECH CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912475609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1019 TOWN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND HEIGHTS
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41076-9114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-441-8876
Provider Business Mailing Address Fax Number:
859-441-5850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
364 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-6604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-907-4506
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/12/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CRAWFORD
Authorized Official First Name:
GREG
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
859-441-8876

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)