Organization
COASTAL PROSTHETICS AND ORTHOTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRITTANY SIVERD (ADMINISTRATIVE EXECUTIVE)
(757) 892-5300
Entity
Organization
Contact information
Practice address
1134 N ROAD ST, ELIZABETH CITY, NC 27909-3322
(757) 892-5300
(757) 892-5303
Mailing address
433 NETWORK STA, CHESAPEAKE, VA 23320-3851
(757) 892-5300
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1029129
ACM
VA
01
—
39563
SENTARA
VA
01
—
434534
BCBS
VA
05
—
9190414
—
VA
Enumeration date
11/07/2019
Last updated
11/07/2019
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