Provider Demographics
NPI:1225352776
Name:COASTAL DIAGNOSTIC TESTING GROUP LLC
Entity type:Organization
Organization Name:COASTAL DIAGNOSTIC TESTING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GERAMI
Authorized Official - Suffix:
Authorized Official - Credentials:CRTT
Authorized Official - Phone:541-756-7710
Mailing Address - Street 1:1810 MONROE ST.
Mailing Address - Street 2:STE 14
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3447
Mailing Address - Country:US
Mailing Address - Phone:541-329-0099
Mailing Address - Fax:541-329-0063
Practice Address - Street 1:1810 MONROE ST.
Practice Address - Street 2:STE 14
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-3447
Practice Address - Country:US
Practice Address - Phone:541-756-7710
Practice Address - Fax:541-756-7699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic