Healthcare Provider Details

I. General information

NPI: 1639647324
Provider Name (Legal Business Name): COASTAL MED-TECH CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 COLLEGE AVE
WATERVILLE ME
04901-6219
US

IV. Provider business mailing address

1019 TOWN DR
HIGHLAND HEIGHTS KY
41076-9114
US

V. Phone/Fax

Practice location:
  • Phone: 800-773-6511
  • Fax: 207-872-7310
Mailing address:
  • Phone: 859-441-8876
  • Fax: 859-441-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: GREG CRAWFORD
Title or Position: PRESIDENT
Credential:
Phone: 859-441-8876