Organization
COASTAL MEDICAL TRANSPORT, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIM BAZEMORE JR. (OWNER)
(252) 794-4149
Entity
Organization
Contact information
Practice address
101 S GRANVILLE ST, WINDSOR, NC 27983-2148
(252) 794-4149
(252) 794-3477
Mailing address
101 S GRANVILLE ST, WINDSOR, NC 27983-2148
(252) 794-4149
(252) 794-3477
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
1556
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0729R
BLUECROSS BLUE SHIELD
NC
05
—
3406822
—
NC
Enumeration date
01/16/2007
Last updated
04/04/2008
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