Coastal Medical, Inc.
Organization Active NPI Non-Pharmacy Dispensing Site · Johnston, RI
NPI 1992847099 · NPPES record last updated Oct 17, 2012
Key facts
- NPI
- 1992847099
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Non-Pharmacy Dispensing Site 332900000X
- License
- MD05547 (RI)
- Legal business name
- COASTAL MEDICAL, INC.
- Practice address
- 1524 Atwood Ave
Ste. 340
Johnston, RI 02919-3228 - Phone
- (401) 949-0300
- NPI assigned
- Feb 13, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- MEDVANTX,INC.
Authorized official
- Name
- Kenny Heine
- Title
- Dir. of Operations
- Phone
- (858) 625-2990
Corporate family (same tax ID) 13
Practitioners 2
-
Deborah Thomas, PA
-
Mark D. Jacobs, MD
National Provider Directory
- Tax ID family
- Lynn a Haughey NPP
- Part of
- Tri - State Medical Group Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Non-Pharmacy Dispensing Site | 332900000X | MD05547 | RI | Yes |
Addresses
Primary practice location
1524 Atwood Ave
Ste. 340
Johnston, RI 02919-3228
Mailing address
5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705
Other providers in Johnston, RI
- Victoria Grace Christie
- Michael C Chu
- Dino Ciarniello
- Robert Michael Cicione
- Nicole Clark
- Chancelor Coffey
- Steven Marc Colagiovanni
- Alexandrea Elena Colangelo
- Marcella Marie Colardo
- Kevin Colasurdo
All providers in Johnston, 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 Oct 17, 2012. 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.