Provider Demographics
NPI:1578598793
Name:COASTAL CARE CORPORATION
Entity Type:Organization
Organization Name:COASTAL CARE CORPORATION
Other - Org Name:MARTIN MEMORIAL MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBITAILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-223-4903
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0959
Mailing Address - Country:US
Mailing Address - Phone:772-223-4903
Mailing Address - Fax:772-223-5622
Practice Address - Street 1:625 SE RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2502
Practice Address - Country:US
Practice Address - Phone:772-221-2002
Practice Address - Fax:772-223-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4102261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCA5218OtherRR MEDICARE
FLHQ870BMedicare PIN