Provider Demographics
NPI:1003618406
Name:FLORIDA COAST MEDICAL AND SURGICAL CENTER, INC.
Entity type:Organization
Organization Name:FLORIDA COAST MEDICAL AND SURGICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:IWANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-827-5386
Mailing Address - Street 1:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-0591
Mailing Address - Country:US
Mailing Address - Phone:772-309-8500
Mailing Address - Fax:772-607-5256
Practice Address - Street 1:310 SE VERANDA FALLS WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-2101
Practice Address - Country:US
Practice Address - Phone:772-309-8500
Practice Address - Fax:772-607-5256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital