# COASTAL AMBULANCE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Coastal Ambulance
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013284603
- **Authorized official:** DR. VLASTIMIL SMETKA M.D. (OWNER/MEDICAL DIRECTOR)
- **Authorized official phone:** (888) 935-5525

## Contact information

- **Practice address:** 415 ROBERTSON BLVD STE B, WALTERBORO, SC 29488-5713
- **Practice address phone:** (888) 935-5525
- **Mailing address:** 478 CESSNA AVE, CHARLESTON, SC 29407-2245
- **Mailing address phone:** (404) 695-8420
- **Mailing address fax:** (864) 643-2485

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 295 | SC | Yes |

## Other

- **Enumeration date:** 11/26/2011
- **Last updated:** 08/03/2012