Coastal Imaging Inc

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

53741 Issued in MA

Legal business name

COASTAL IMAGING INC

Practice address

20020 Veterans Blvd
Port Charlotte, FL 33954-2112

Phone

(941) 629-9877

Fax

(941) 766-0001

NPI assigned

Mar 25, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lisa Boucher

Title

Ultrasound Tech

Phone

(941) 421-2116

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206403200000",
    "number": "1053583526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26092 OCELOT LN",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339836131",
            "telephone_number": "941-629-9877",
            "fax_number": "941-766-0001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20020 VETERANS BLVD",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339542112",
            "telephone_number": "941-629-9877",
            "fax_number": "941-766-0001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL IMAGING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-25",
        "last_updated": "2008-03-25",
        "status": "A",
        "authorized_official_last_name": "BOUCHER",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "ULTRASOUND TECH",
        "authorized_official_telephone_number": "941-421-2116"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "MA",
            "license": "53741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Radiology Clinic/Center in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Radiology Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.