Healthcare Provider Details

I. General information

NPI: 1134155575
Provider Name (Legal Business Name): COASTAL AMBULANCE CO.,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 THOMAS LOOP RD
JACKSONVILLE NC
28540-8518
US

IV. Provider business mailing address

194 THOMAS LOOP RD
JACKSONVILLE NC
28540-8518
US

V. Phone/Fax

Practice location:
  • Phone: 910-324-6304
  • Fax: 910-324-3040
Mailing address:
  • Phone: 910-324-6304
  • Fax: 910-324-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number0520902
License Number StateNC

VIII. Authorized Official

Name: MR. H.STEVEN PRIDGEN
Title or Position: OWNER/DIRECTOR
Credential: TEACHER,PARAMEDIC
Phone: 910-324-6304