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COASTAL MEDICAL - ELMHURST
NPI 1114124864
Non-Pharmacy Dispensing Site in Providence, RI

Active since June 27, 2007
1075 SMITH ST, 2ND FLOOR, PROVIDENCE, RI 02908(401) 421-4400 Get Directions Write a Review

NPPES record last updated: October 24, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Coastal Medical - Elmhurst NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COASTAL MEDICAL - ELMHURST (NPI 1114124864) is a healthcare organization registered as a non-pharmacy dispensing site in Providence, Rhode Island and active in the NPI registry since June 2007. The organization lists Kenny Heine, Vp Of Operations, as its authorized official.

NPPES Registry Identity

NPI1114124864
Entity TypeOrganization
Primary Taxonomy332900000X
Legal Business NameCOASTAL MEDICAL, INC.
Location Address1075 SMITH ST, 2ND FLOORProvidence, RI 02908-2700
Mailing Address5626 Oberlin Dr, Suite 110San Diego, CA 92121-1705 · (858) 625-2990
Phone(401) 421-4400
Organization SubpartYesParent: Medvantx, Inc
Authorized OfficialKenny HeineVp Of Operations · (858) 625-2990
Enumeration DateJune 27, 2007
Last NPPES UpdateOctober 24, 2013
✔ NPI 1114124864 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNon-Pharmacy Dispensing SiteSuppliers
Taxonomy Code332900000X
License✔ Licensed in RI · MD08852
Definition
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)
1075 SMITH ST, Providence, RI 02908
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Other Names 1

Doing Business AsCoastal Medical - Elmhurst

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PROVIDENCE BEHAVIORAL HEALTH ASSOCIATES INC
Psychologist (Clinical)
1075 SMITH ST
PROVIDENCE, RI 02908
Providence County (401) 369-9224
MS. MEGAN STRATHEARN LICSW
Social Worker
1075 SMITH ST
PROVIDENCE, RI 02908
Providence County (401) 369-9224
BRIAN J ALBANO DPM
Durable Medical Equipment & Medical Supplies
1075 SMITH ST
PROVIDENCE, RI 02908
Providence County (401) 273-0600
MS. FAWAZAT MARIA AGORO PMHNP
Nurse Practitioner (Psychiatric/Mental Health)
1075 SMITH ST
PROVIDENCE, RI 02908
Providence County (401) 369-9224
ALEXIS LOUISE DIGASSO PSYD
Psychologist
1075 SMITH ST
PROVIDENCE, RI 02908
Providence County (401) 369-9224
ELIZABETH ANNE MANGIAMELI LICSW
Social Worker (Clinical)
1075 SMITH ST
PROVIDENCE, RI 02908
Providence County (401) 369-9224
DR. TANIA GONZALEZ SANCHEZ PHD
Psychologist (Clinical)
1075 SMITH ST
PROVIDENCE, RI 02908
Providence County (401) 369-9224
DR. BRIAN J ALBANO DPM
Podiatrist
1075 SMITH ST
PROVIDENCE, RI 02908
Providence County (401) 273-0600

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Coastal Medical, Inc.'s NPI number?

The NPI number for Coastal Medical, Inc. is 1114124864. It was assigned to this organization in the NPPES registry on June 27, 2007. The provider is doing business as Coastal Medical - Elmhurst.

Where is Coastal Medical, Inc. located?

Coastal Medical, Inc. is located at 1075 Smith St 2nd Floor, Providence, RI 02908. The listed phone number is (401) 421-4400.

What is Coastal Medical, Inc.'s specialty?

The primary specialty registered for this NPI is Non-Pharmacy Dispensing Site with taxonomy code 332900000X.

When was this NPI record last updated?

The NPPES record for Coastal Medical, Inc. was last updated on October 24, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.