MEDICARE: COASTAL HEALTH SUPPLIES

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	2085R0204X	Vascular & Interventional Radiology Physician

General Provider Information

NPI Number	:	1598690208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL HEALTH SUPPLIES

Provider Business Mailing Address
First Line	:	208 MAGNOLIA DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5305 GRAND BLVD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4014
Country	:	US
Telephone Number	:	727-247-5977
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	HUDSON ROWAN
Credential	:
Telephone Number	:	727-247-5977

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “COASTAL HEALTH SUPPLIES ” Practice Location

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