Organization
COASTAL IMAGING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA BOUCHER (ULTRASOUND TECH)
(941) 421-2116
Entity
Organization
Contact information
Practice address
20020 VETERANS BLVD, PORT CHARLOTTE, FL 33954-2112
(941) 629-9877
(941) 766-0001
Mailing address
26092 OCELOT LN, PUNTA GORDA, FL 33983-6131
(941) 629-9877
(941) 766-0001
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
53741
MA
Other
Enumeration date
03/25/2008
Last updated
03/25/2008
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