Coastal Medical, Inc.
Organization Active NPI Non-Pharmacy Dispensing Site · Wakefield, RI
NPI 1720128499 · NPPES record last updated Apr 24, 2013
Key facts
- NPI
- 1720128499
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Non-Pharmacy Dispensing Site 332900000X
- License
- MD06582 (RI)
- Legal business name
- COASTAL MEDICAL, INC.
- Practice address
- 70 Kenyon Ave
Suite 321
Wakefield, RI 02879-4239 - Phone
- (401) 783-0084
- Fax
- (401) 782-0005
- NPI assigned
- Feb 8, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- MEDVANTX,INC
Authorized official
- Name
- Mr. Kenny Heine
- Title
- VP of Operations
- Phone
- (858) 625-2990
Corporate family (same tax ID) 13
Practitioners 1
National Provider Directory
- Tax ID family
- Lynn a Haughey NPP
- Part of
- Tri - State Medical Group Inc
Locations
70 Kenyon Ave
Ste 321
Wakefield, RI 02879
Phone (401) 783-0084
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Non-Pharmacy Dispensing Site | 332900000X | MD06582 | RI | Yes |
Addresses
Primary practice location
70 Kenyon Ave
Suite 321
Wakefield, RI 02879-4239
Mailing address
5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705
Phone (858) 625-2990
Other names
- Coastal Medical - Wakefield Medical
Other providers in Wakefield, RI
- Mary Clair-Michaud
- Cory Clark
- Patricia R Clark
- Club Wellbeing LLC
- CMB Wellness LLC
- Chad Coffin
- Sally Anne Cole-Major
- Jessica Coliflores
- Abram Collard
- Dominique Marie Collins
All providers in Wakefield, RI · Non-Pharmacy Dispensing Site in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.