Provider Profile
COASTLINE IMAGING LLC
Health Care Clinic
FACILITY PROFILE
Accredited by: American College of Radiology
Street Address
- 2290 W EAU GALLIE BLVD 104
MELBOURNE, FL 32935
County: Brevard - Phone: (321) 253-2700
Mailing Address
- 2290 W EAU GALLIE BLVD 104
MELBOURNE, FL 32935
County: Brevard - Phone: (813) 325-1389
AHCA Reports
Inspection ReportsInspection Details
Facility Information:
| Facility/Provider Type: | Health Care Clinic | |||||||||||||||
| Medical or Clinic Director: | VIKRAM KRISHAN SOBTI | |||||||||||||||
| Administrator: | JENNIFER JOHNSON | |||||||||||||||
| Owner/Licensee: | COASTLINE IMAGING, LLC | |||||||||||||||
| Owner/Licensee Since: | 10/13/2008 | |||||||||||||||
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| Profit Status: | For-Profit | |||||||||||||||
| Licensed Beds: | Not Available | |||||||||||||||
| AHCA Number (File Number): | 4653 | |||||||||||||||
| AHCA Field Office: | 07 | |||||||||||||||
| License Number: | 3989 | |||||||||||||||
| Current License Effective: | 3/15/2024 | |||||||||||||||
| Current License Expires: | 3/14/2026 | |||||||||||||||
| License Status: | LICENSED | |||||||||||||||
Services/Characteristics
| Specialty: | PIP Recipient |
| Type: | Fixed Location |
Legal Actions
| Date Initiated | Case # | Case Type | Violation | Fine Amount | Date Imposed |
|---|---|---|---|---|---|
| Change of ownership occurred 3/15/2022 | |||||
| 3/22/2019 | 2020008194 | Fine | Survey | $6,000.00 | 6/2/2021 |
Important information and facility/provider definitions can be found in the Glossary.
Attn Providers: Requests for changes in data must be sent in writing to the AHCA licensing office.