Healthcare Provider Details

I. General information

NPI: 1467733774
Provider Name (Legal Business Name): COASTAL PAIN SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SE OCEAN BLVD SUITE 100
STUART FL
34996-3332
US

IV. Provider business mailing address

75 REMITTANCE DR SUITE 6633
CHICAGO IL
60675-6633
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-2115
  • Fax: 772-223-0887
Mailing address:
  • Phone: 772-223-2115
  • Fax: 772-223-0887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARC I LEVINE
Title or Position: PRESIDENT
Credential: MD
Phone: 772-337-7676