NPIMap

Organization Active NPI

Coastal Medical Inc

  • Clinical Medical Laboratory
  • Providence, RI
National Provider Identifier
1972590552
Registry record updated Feb 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
00412 Issued in RI
Legal business name
COASTAL MEDICAL INC
Practice address
272 W Exchange St
Suite 100
Providence, RI 02903-1061
Phone
(401) 421-5434
Fax
(401) 421-4633
NPI assigned
Sep 29, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2017

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

Authorized official

Name
Meryl Moss
Title
Coo
Phone
(401) 421-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 00412 RI Primary

Addresses

Primary practice location

272 W Exchange St
Suite 100
Providence, RI 02903-1061

Mailing address

10 Davol SQ
Suite 400
Providence, RI 02903-4754
Phone (401) 421-4000

Other identifiers 1

IdentifierTypeStateIssuer
1972590MedicaidRI

Other names 1

  • COASTAL MEDICAL LAB Doing business as

National Provider Directory

National Provider Directory

Locations

10 Davol Sq
Ste 200
Providence, RI 02903

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486339200000",
    "number": "1972590552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 DAVOL SQ",
            "address_2": "SUITE 400",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034754",
            "telephone_number": "401-421-4000",
            "fax_number": "401-272-1456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "272 W EXCHANGE ST",
            "address_2": "SUITE 100",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029031061",
            "telephone_number": "401-421-5434",
            "fax_number": "401-421-4633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2017-02-06",
        "status": "A",
        "authorized_official_last_name": "MOSS",
        "authorized_official_first_name": "MERYL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "401-421-4000"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "RI",
            "license": "00412",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1972590",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COASTAL MEDICAL LAB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Providence, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2017; 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.