| Organization Name: | COASTAL AMBULANCE LLC |
| NPI Number: | 1013284603 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VLASTIMIL SMETKA (OWNER/MEDICAL DIRECTOR) |
| Mailing Address: | 415 Robertson Blvd Ste B Walterboro |
| State: | SC US |
| Postal Code: | 294885713 |
| Phone Number: | 8889355525 |
| Fax Number: | |
| NPI Enumeration Date: | 11/26/2011 |
| NPI Last Update Date: | 08/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3416L0300X |
| License Number: | 295 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Ambulance |
| Taxonomy Specialization: | Land Transport |
| Taxonomy Definition: | |