Coastal Care Corporation

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

110680041014466 Issued in FL

Legal business name

COASTAL CARE CORPORATION

Doing business as

MARTIN MEMORIAL MEDICENTER AT ST LUCIE WEST

Practice address

1095 NW Saint Lucie West Blvd
Port St Lucie, FL 34986-1719

Phone

(772) 785-5500

Fax

(772) 785-5598

NPI assigned

Jan 9, 2007

Organization subpart

No

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

Authorized official

Name

Markey Debbie

Title

Manager

Phone

(772) 785-5510

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MARTIN MEMORIAL MEDICENTER AT ST LUCIE WEST Doing business as

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377561600000",
    "number": "1821147059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 417",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349950417",
            "telephone_number": "772-223-5665",
            "fax_number": "772-223-5646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 NW SAINT LUCIE WEST BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349861719",
            "telephone_number": "772-785-5500",
            "fax_number": "772-785-5598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2013-08-27",
        "status": "A",
        "authorized_official_last_name": "DEBBIE",
        "authorized_official_first_name": "MARKEY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "772-785-5510"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "110680041014466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "064696207",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARTIN MEMORIAL MEDICENTER AT ST LUCIE WEST",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2013; 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.