MEDICARE: COASTAL MEDICAL EQUIPMENT 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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1417601592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL MEDICAL EQUIPMENT LLC

Provider Business Mailing Address
First Line	:	450 E PASS RD STE 1
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39507-3212
Country	:	US
Telephone Number	:	228-731-3313
Fax Number	:	228-731-3313

Provider Business Practice Location Address
First Line	:	450 E PASS RD STE 1
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39507-3212
Country	:	US
Telephone Number	:	228-731-3313
Fax Number	:	833-346-0381

Authorized Official
Title or Position	:	OWNER
Name	:	CINDA TERREBONNE
Credential	:
Telephone Number	:	228-731-3313

Provider Enumeration Date	:	02/08/2022
Last Update Date	:	12/01/2022

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