Provider Demographics
NPI:1992063440
Name:COASTAL MED TECH INC
Entity type:Organization
Organization Name:COASTAL MED TECH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SEVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-848-7152
Mailing Address - Street 1:376 NORTH STREETSUITE C
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619
Mailing Address - Country:US
Mailing Address - Phone:207-454-0402
Mailing Address - Fax:207-454-0421
Practice Address - Street 1:376 NORTH MAINE STREET
Practice Address - Street 2:SUITE C
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619
Practice Address - Country:US
Practice Address - Phone:207-454-0402
Practice Address - Fax:207-454-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME11886000332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0481350005Medicare NSC