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General NPI Number Information
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NPI Number | 1356651673
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Entity Type | Organization
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Legal Business Name | COASTAL CARE MEDICAL SUPPLY, INC.
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 755 NW 17TH AVE 105
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City | DELRAY BEACH
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State | FL
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Zip | 33445-2522
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Country | US
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Telephone | 561-265-4310
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Fax | 561-214-4004
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Provider Business Mailing Address
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Address Line | 1800 W WOOLBRIGHT RD 200
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-6398
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Country | US
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Telephone | 561-819-0460
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Fax | 561-207-7781
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JONATHAN JAMES FEDELE
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Credential |
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Telephone | 561-265-4310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1887
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License Number State | FL
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