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General NPI Number Information
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NPI Number | 1003848748
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Entity Type | Organization
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Legal Business Name | COASTAL OXYGEN & MEDICAL SUPPLY, LLC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2411 EXECUTIVE PLAZA DR
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City | PENSACOLA
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State | FL
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Zip | 32504-8269
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Country | US
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Telephone | 850-477-9384
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Fax | 850-476-9519
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Provider Business Mailing Address
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Address Line | 2411 EXECUTIVE PLAZA DR
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City | PENSACOLA
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State | FL
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Zip | 32504-8269
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Country | US
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Telephone | 850-477-9384
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Fax | 850-476-9519
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Authorized Official
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Title or Position | MEMBER
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Name | MR. DONALD R PADGET
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Credential |
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Telephone | 850-477-9384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 1312081
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License Number State | FL
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