MEDICARE: COASTAL MEDICAL SERVICES, 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	251E00000X	Home Health Agency	005445	TX

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	:	1144305004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL MEDICAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	8303 SOUTHWEST FWY STE 820
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1638
Country	:	US
Telephone Number	:	713-771-8470
Fax Number	:	713-771-8474

Provider Business Practice Location Address
First Line	:	8303 SOUTHWEST FWY STE 820
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1638
Country	:	US
Telephone Number	:	713-771-8470
Fax Number	:	713-771-8474

Authorized Official
Title or Position	:	DON/ALTERNATE ADMINISTRATOR
Name	:	MRS. IMEH OKPON JACK
Credential	:	RN
Telephone Number	:	713-771-8470

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	02/02/2012

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Directions to “COASTAL MEDICAL SERVICES, INC. ” Practice Location

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