MEDICARE: COASTAL AMBULANCE CO.,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	146N00000X	Basic Emergency Medical Technician	0520902	NC

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	:	1134155575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL AMBULANCE CO.,INC

Provider Business Mailing Address
First Line	:	194 THOMAS LOOP RD
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-8518
Country	:	US
Telephone Number	:	910-324-6304
Fax Number	:	910-324-3040

Provider Business Practice Location Address
First Line	:	194 THOMAS LOOP RD
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-8518
Country	:	US
Telephone Number	:	910-324-6304
Fax Number	:	910-324-3040

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MR. H.STEVEN PRIDGEN
Credential	:	TEACHER,PARAMEDIC
Telephone Number	:	910-324-6304

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	08/22/2020

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