Healthcare Provider Details

I. General information

NPI: 1265590699
Provider Name (Legal Business Name): COASTAL MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 NORTHPORT AVE
BELFAST ME
04915-6009
US

IV. Provider business mailing address

PO BOX 407
BELFAST ME
04915-0407
US

V. Phone/Fax

Practice location:
  • Phone: 207-338-8412
  • Fax: 207-338-8368
Mailing address:
  • Phone: 207-338-8412
  • Fax: 207-338-8368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDA B DRINKWATER
Title or Position: CFO
Credential:
Phone: 207-338-2500