Coastal Medical Transport, Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

1556 Issued in NC

Legal business name

COASTAL MEDICAL TRANSPORT, INC

Practice address

101 S Granville St
Windsor, NC 27983-2148

Phone

(252) 794-4149

Fax

(252) 794-3477

NPI assigned

Jan 16, 2007

Last updated

Apr 4, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Tim Bazemore Jr.

Title

Owner

Phone

(252) 794-4149

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207267200000",
    "number": "1104977198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 S GRANVILLE ST",
            "city": "WINDSOR",
            "state": "NC",
            "postal_code": "279832148",
            "telephone_number": "252-794-4149",
            "fax_number": "252-794-3477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S GRANVILLE ST",
            "city": "WINDSOR",
            "state": "NC",
            "postal_code": "279832148",
            "telephone_number": "252-794-4149",
            "fax_number": "252-794-3477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL MEDICAL TRANSPORT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2008-04-04",
        "status": "A",
        "authorized_official_last_name": "BAZEMORE",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-794-4149",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "NC",
            "license": "1556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUE SHIELD",
            "identifier": "0729R",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406822",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Land Ambulance in Windsor, NC
• Providers in Windsor, NC by specialty
• Land Ambulance in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.