Basic Information
| Provider Information | |||||||||
| NPI: | 1003848748 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COASTAL OXYGEN & MEDICAL SUPPLY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2411 EXECUTIVE PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504779384 | ||||||||
| FaxNumber: | 8504769519 | ||||||||
| Practice Location | |||||||||
| Address1: | 2411 EXECUTIVE PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504779384 | ||||||||
| FaxNumber: | 8504769519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PADGET | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8504779384 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | 1312081 | FL | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
No ID Information.