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General NPI Number Information
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NPI Number | 1316966336
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Entity Type | Organization
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Legal Business Name | COASTAL CARE CORPORATION
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 509 SE RIVERSIDE DR
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City | STUART
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State | FL
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Zip | 34994-2579
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Country | US
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Telephone | 772-223-4903
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Fax | 772-223-5622
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Provider Business Mailing Address
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Address Line | PO BOX 9033
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City | STUART
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State | FL
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Zip | 34995-9033
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Country | US
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Telephone | 772-223-4903
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Fax | 772-223-5622
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. MARK R ROBITAILLE
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Credential |
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Telephone | 772-223-4903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 904
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License Number State | FL
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