Healthcare Provider Details

I. General information

NPI: 1699666032
Provider Name (Legal Business Name): COASTAL DME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 EXECUTIVE AVE STE A1
MYRTLE BEACH SC
29577-6593
US

IV. Provider business mailing address

2200 EXECUTIVE AVE STE A1
MYRTLE BEACH SC
29577-6593
US

V. Phone/Fax

Practice location:
  • Phone: 843-712-2948
  • Fax: 843-350-9960
Mailing address:
  • Phone: 843-712-2948
  • Fax: 843-350-9960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JAMES CHAPMAN
Title or Position: OWNER
Credential:
Phone: 423-394-1440