Provider Demographics
NPI:1083442826
Name:FIRST COAST MEDICAL & DENTAL SUPPLY, LLC
Entity type:Organization
Organization Name:FIRST COAST MEDICAL & DENTAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LADD
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-881-1804
Mailing Address - Street 1:140 N ONE DR STE B
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8372
Mailing Address - Country:US
Mailing Address - Phone:904-460-2549
Mailing Address - Fax:904-814-8380
Practice Address - Street 1:140 N ONE DR STE B
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8372
Practice Address - Country:US
Practice Address - Phone:904-460-2549
Practice Address - Fax:904-814-8380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies