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NPI Code Detail

MEDICARE: COASTAL PROSTHETICS AND ORTHOTICS, LLC

MEDICARE: COASTAL PROSTHETICS AND ORTHOTICS, LLC
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
1335E00000XProsthetic/Orthotic Supplier

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164990040
Entity Type Code : Organization
Provider Name (Legal Business Name) : COASTAL PROSTHETICS AND ORTHOTICS, LLC
Provider Business Mailing Address
First Line : 433 NETWORK STA
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23320-3851
Country : US
Telephone Number : 757-892-5300
Fax Number : 757-892-5303
Provider Business Practice Location Address
First Line : 433 NETWORK STA
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23320-3851
Country : US
Telephone Number : 757-892-5300
Fax Number : 757-892-5303
Authorized Official
Title or Position : ADMINISTRATOR
Name : KAREN VAUGHN
Credential :
Telephone Number : 757-828-5112
Provider Enumeration Date : 11/08/2018
Last Update Date : 07/02/2019

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Directions to “COASTAL PROSTHETICS AND ORTHOTICS, LLC ” Practice Location

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