Organization
COAST MEDICAL SUPPLY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD E. MATTIACE (PRESIDENT/CEO)
(228) 374-0227
Entity
Organization
Contact information
Practice address
951 HOWARD AVE, BILOXI, MS 39530-3762
(228) 374-2273
(228) 374-0661
Mailing address
PO BOX 1093, BILOXI, MS 39533-1093
(228) 374-0227
(228) 374-0661
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
03729/11.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00440306
—
MS
Enumeration date
11/01/2006
Last updated
08/22/2020
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