Provider Demographics
NPI:1861958217
Name:COAST DME CORP
Entity type:Organization
Organization Name:COAST DME CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:CHANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-274-6577
Mailing Address - Street 1:18672 FLORIDA ST STE 202B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6088
Mailing Address - Country:US
Mailing Address - Phone:714-274-6577
Mailing Address - Fax:800-217-7840
Practice Address - Street 1:18672 FLORIDA ST STE 202B
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-6088
Practice Address - Country:US
Practice Address - Phone:714-274-6577
Practice Address - Fax:800-217-7840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies