Healthcare Provider Details

I. General information

NPI: 1992858237
Provider Name (Legal Business Name): COASTAL CAROLINA RESPIRATORY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 E MAIN ST
BEULAVILLE NC
28518-8714
US

IV. Provider business mailing address

802 E MAIN ST
BEULAVILLE NC
28518-8714
US

V. Phone/Fax

Practice location:
  • Phone: 910-298-6007
  • Fax: 910-298-6009
Mailing address:
  • Phone: 910-298-6007
  • Fax: 910-298-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: DWAYNE WEITZEL
Title or Position: PRESIDENT/OWNER
Credential: BS, RRT, RCP
Phone: 724-996-9409