Organization
COASTLINE IMAGING LLC
Active
Other names
Encore Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA KASSA (COMPLIANCE OFFICER)
(904) 640-9129
Entity
Organization
Contact information
Practice address
2290 W EAU GALLIE BLVD STE 104, MELBOURNE, FL 32935-3134
(321) 253-2700
(321) 253-2267
Mailing address
2290 W EAU GALLIE BLVD, STE 104, MELBOURNE, FL 32935-3133
(321) 253-2700
(321) 253-2267
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
HCC3989
FL
2085U0001X
Diagnostic Ultrasound Physician
HCC3989
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V2122
BCBS FL
FL
Enumeration date
08/31/2005
Last updated
07/11/2025
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