NPIMap

Organization Active NPI

Pacific Coast Medical Supply, LLC

  • Durable Medical Equipment & Medical Supplies
  • Oceanside, CA
National Provider Identifier
1801268628
Registry record updated Oct 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PACIFIC COAST MEDICAL SUPPLY, LLC
Practice address
1155 Sportfisher Dr
Suite 210
Oceanside, CA 92054-4168
Phone
(562) 706-4552
Fax
(877) 733-3462
NPI assigned
Oct 21, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2015

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

Authorized official

Name
Ms. Carie Mortensen
Title
Ceo/President
Phone
(562) 706-4552

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X CA Primary

Addresses

Primary practice location

1155 Sportfisher Dr
Suite 210
Oceanside, CA 92054-4168

Mailing address

1155 Sportfisher Dr
Suite 210
Oceanside, CA 92054-4168
Phone (562) 706-4552

National Provider Directory

National Provider Directory
Tax ID family
Gold Coast Diabetes3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1155 Sportfisher Dr
Ste 210
Oceanside, CA 92054
Phone (562) 706-4552

NPI Registry JSON

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

{
    "created_epoch": "1445385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445385600000",
    "number": "1801268628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 SPORTFISHER DR",
            "address_2": "SUITE 210",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920544168",
            "telephone_number": "562-706-4552",
            "fax_number": "877-733-3462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 SPORTFISHER DR",
            "address_2": "SUITE 210",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920544168",
            "telephone_number": "562-706-4552",
            "fax_number": "877-733-3462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC COAST MEDICAL SUPPLY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-21",
        "last_updated": "2015-10-21",
        "status": "A",
        "authorized_official_last_name": "MORTENSEN",
        "authorized_official_first_name": "CARIE",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "562-706-4552",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oceanside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2015; 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.