Organization
COASTAL CARE CORPORATION
Active
Other names
MARTIN MEMORIAL MEDICENTER AT ST LUCIE WEST
Organization subpart
No
Provider details
NPI number
Authorized official
MARKEY DEBBIE (MANAGER)
(772) 785-5510
Entity
Organization
Contact information
Practice address
1095 NW SAINT LUCIE WEST BLVD, PORT ST LUCIE, FL 34986-1719
(772) 785-5500
(772) 785-5598
Mailing address
PO BOX 417, STUART, FL 34995-0417
(772) 223-5665
(772) 223-5646
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
110680041014466
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064696207
—
FL
Enumeration date
01/09/2007
Last updated
08/27/2013
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