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General NPI Number Information
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NPI Number | 1598422909
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Entity Type | Organization
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Legal Business Name | COASTAL CAROLINA CPR LLC.
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Dates
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Enumeration Date | 11/19/2021
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 325 SOUND RD
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City | HOLLY RIDGE
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State | NC
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Zip | 28445-7813
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Country | US
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Telephone | 910-399-3744
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 15470
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City | WILMINGTON
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State | NC
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Zip | 28408-5470
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Country | US
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Telephone | 910-399-3744
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. NICHOLAS TODD TRIPP
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Credential | ADVANCED EMT
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Telephone | 910-399-3744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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