Organization
INTRACOASTAL SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. COLLIN LEMAISTRE III (OFFICER/AUTHORIZED OFFICIAL)
(214) 213-0732
Entity
Organization
Contact information
Practice address
2200 W EAU GALLIE BLVD STE 100, MELBOURNE, FL 32935-3166
(321) 795-6095
Mailing address
2200 W EAU GALLIE BLVD STE 100, MELBOURNE, FL 32935-3166
(321) 795-6095
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
08/08/2018
Last updated
02/18/2026
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