Organization
COASTAL CARE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT LORD (CEO)
(772) 223-4903
Entity
Organization
Contact information
Practice address
1651 SE TIFFANY AVE STE 100, PORT ST LUCIE, FL 34952-7564
(772) 223-4923
(772) 223-5622
Mailing address
PO BOX 959, STUART, FL 34995-0959
(772) 223-4923
(772) 223-5622
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
09/10/2009
Last updated
12/11/2018
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