MEDICARE: COASTAL LABORATORIES OF FLORIDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1710541156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL LABORATORIES OF FLORIDA

Provider Business Mailing Address
First Line	:	260 MAITLAND AVE STE A
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5510
Country	:	US
Telephone Number	:	407-474-1214
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 MAITLAND AVE STE A
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5510
Country	:	US
Telephone Number	:	407-474-1214
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	STEVE SCHINDEHETTE
Credential	:
Telephone Number	:	407-474-1214

Provider Enumeration Date	:	04/30/2019
Last Update Date	:	04/30/2019

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