COASTAL CARE CORPORATION – NPI #1558320556
Clinic/Center

COASTAL CARE CORPORATION is an AHC clinic located in PORT SAINT LUCIE, FL. NPPES has assigned the NPI number 1558320556 to COASTAL CARE CORPORATION on March 20, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. This provider is also associated with 2 additional names listed below. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 261QR0200X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Radiology

The NPI profile was last updated on Aug 08, 2025. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for COASTAL CARE CORPORATION below.

NPI Profile for
COASTAL CARE CORPORATION

NPI Number
1558320556
Enumeration Date

(more than 20 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
COASTAL CARE CORPORATION
Other name(s)
All associated names:
Doing Business As (dba)
CLEVELAND CLINIC IMAGING
Doing Business As (dba)
MARTIN MEMORIAL DIAGNOSTIC SERVICES AT SAINT LUCIE WEST
Primary location
1095 NW SAINT LUCIE WEST BLVD
PORT SAINT LUCIE, FL 34986-1719
Phone: (772) 785-5502 Fax: (772) 223-5622
Mailing address
6801 BRECKSVILLE RD
STE 20 ATTN: DPC RK2-7
INDEPENDENCE, OH 44131-5062
Phone: (216) 636-4969 Fax: (216) 636-6063
Organization Subpart
No
Authorized Official
DENNIS LARAWAY
EXECUTIVE VP CHIEF FINANCE OFFICER
Phone: (216) 445-1343
Updated
Certification Date
Aug 08, 2025

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for COASTAL CARE CORPORATION

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
otherBLUE CROSSFLV2390
otherRR MEDICAREFLCA5218
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QR0200X
- Clinic/Center / Radiology (Primary)
FL 4102
261QR0206X
- Clinic/Center / Radiology, Mammography
FL 4102
261QM1200X
- Clinic/Center / Magnetic Resonance Imaging (MRI)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.