MEDICARE: COASTAL FERRY 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	341600000X	Ambulance
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1912592031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL FERRY LLC

Provider Business Mailing Address
First Line	:	4912 RUTHERFORD RD STE 105
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-4040
Country	:	US
Telephone Number	:	757-201-9875
Fax Number	:

Provider Business Practice Location Address
First Line	:	4912 RUTHERFORD RD STE 105
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-4040
Country	:	US
Telephone Number	:	757-201-9875
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WINSTON MILLER HENSLEY III
Credential	:
Telephone Number	:	757-201-9875

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	07/06/2022

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Directions to “COASTAL FERRY LLC ” Practice Location

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