Provider Demographics
NPI:1902176563
Name:COASTLINE MEDICAL, INC.
Entity Type:Organization
Organization Name:COASTLINE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:757-275-8050
Mailing Address - Street 1:509 VIKING DR STE E
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7323
Mailing Address - Country:US
Mailing Address - Phone:757-275-8050
Mailing Address - Fax:888-600-5328
Practice Address - Street 1:509 VIKING DR STE E
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7323
Practice Address - Country:US
Practice Address - Phone:757-275-8050
Practice Address - Fax:888-600-5328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier