Coastline Imaging LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

HCC3989 Issued in FL

Legal business name

COASTLINE IMAGING LLC

Practice address

2290 W Eau Gallie Blvd
Suite 108
Melbourne, FL 32935-3133

Phone

(321) 253-2700

Fax

(321) 253-2267

NPI assigned

Nov 15, 2007

Organization subpart

No

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

Authorized official

Name

James Eaker

Title

President

Phone

(321) 253-2700

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651104000000",
    "number": "1184805491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2290 W EAU GALLIE BLVD",
            "address_2": "SUITE 104",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329353133",
            "telephone_number": "321-253-2700",
            "fax_number": "321-253-2267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2290 W EAU GALLIE BLVD",
            "address_2": "SUITE 108",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329353133",
            "telephone_number": "321-253-2700",
            "fax_number": "321-253-2267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTLINE IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-15",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A",
        "authorized_official_last_name": "EAKER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-253-2700"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "HCC3989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "264871701",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; 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.