Provider Demographics
NPI:1104507805
Name:COASTAL CARE LABS LLC
Entity type:Organization
Organization Name:COASTAL CARE LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OWUSU
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKYI AGYEKUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-437-1529
Mailing Address - Street 1:8291 DANI DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-8021
Mailing Address - Country:US
Mailing Address - Phone:904-437-1529
Mailing Address - Fax:
Practice Address - Street 1:8291 DANI DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-8021
Practice Address - Country:US
Practice Address - Phone:904-437-1529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory