NPIMap

Organization Active NPI

Coastal Medical, Inc.

Doing business as Coastal Medical - Lincoln

  • Non-Pharmacy Dispensing Site
  • Lincoln, RI
National Provider Identifier
1184767030
Registry record updated Oct 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
MD07939 Issued in RI
Legal business name
COASTAL MEDICAL, INC.
Doing business as
Coastal Medical - Lincoln
Practice address
6 Blackstone Valley PL
Suite 701
Lincoln, RI 02865-1179
Phone
(401) 333-3111
NPI assigned
Feb 14, 2007
Last updated
Oct 17, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDVANTX,INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 17, 2012

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

Authorized official

Name
Kenny Heine
Title
Sr. Dir. of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X MD07939 RI Primary

Addresses

Primary practice location

6 Blackstone Valley PL
Suite 701
Lincoln, RI 02865-1179

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705

Other names 1

  • Coastal Medical - Lincoln Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Carol B Lietar NPP14 organizations share this tax ID, including this one
Part of
Medvantx Inc

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

6 Blackstone Valley Pl
Ste 701
Lincoln, RI 02865
Phone (401) 333-3111

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1184767030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 BLACKSTONE VALLEY PL",
            "address_2": "SUITE 701",
            "city": "LINCOLN",
            "state": "RI",
            "postal_code": "028651179",
            "telephone_number": "401-333-3111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL MEDICAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX,INC.",
        "enumeration_date": "2007-02-14",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "SR. DIR. OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "RI",
            "license": "MD07939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Medical - Lincoln",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lincoln, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.