MEDICARE: COASTAL MED TECH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	1142509	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114055407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL MED TECH, INC.

Provider Business Mailing Address
First Line	:	730 CENTER STREET, UNIT 10-C
Second Line	:
City	:	AUBURN
State	:	ME
Zip	:	04210
Country	:	US
Telephone Number	:	207-782-0660
Fax Number	:	207-782-0441

Provider Business Practice Location Address
First Line	:	730 CENTER ST
Second Line	:
City	:	AUBURN
State	:	ME
Zip	:	04210-6316
Country	:	US
Telephone Number	:	207-782-0660
Fax Number	:	207-782-0441

Authorized Official
Title or Position	:	COMPLIANCE OFFICER
Name	:	MS. SHANNON SEVEY
Credential	:
Telephone Number	:	207-848-7152

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	10/13/2016

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Directions to “COASTAL MED TECH, INC. ” Practice Location

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