Coast Healthcare Supply

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

102629 Issued in CA

Legal business name

COAST HEALTHCARE SUPPLY

Doing business as

Karen Markard Jenkins

Practice address

190 E Elm St
Fort Bragg, CA 95437-3026

Phone

(707) 964-1112

Fax

(707) 964-1222

NPI assigned

Oct 25, 2006

Last updated

Aug 22, 2020By 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

Mrs. Diane Dahl

Title

Manager

Phone

(707) 964-1112

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Karen Markard Jenkins Doing business as

Locations

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477637205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E ELM ST",
            "address_2": "P.O. BOX 1330",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954373026",
            "telephone_number": "707-964-1112",
            "fax_number": "707-964-1222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 E ELM ST",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954373026",
            "telephone_number": "707-964-1112",
            "fax_number": "707-964-1222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAST HEALTHCARE SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAHL",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "707-964-1112",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "CA",
            "license": "102629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DME1708F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Karen Markard Jenkins",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Yulee Chang, PHARM.D.
• Coastal Functional Medicine
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• Abraham P Cohen, CMT
• Tabetha Connell
• Phillip Conwell Jr., CRNA

• Oxygen Equipment & Supplies (DME) in Fort Bragg, CA
• Providers in Fort Bragg, CA by specialty
• Oxygen Equipment & Supplies (DME) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.