Healthcare Provider Details

I. General information

NPI: 1528037942
Provider Name (Legal Business Name): EMERALD COAST OXYGEN & MEDICAL EQUIPMENT SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8189B MILLERS ST
LAUREL HILL FL
32567-2118
US

IV. Provider business mailing address

8189B MILLERS ST
LAUREL HILL FL
32567-2118
US

V. Phone/Fax

Practice location:
  • Phone: 850-652-3411
  • Fax: 850-652-2033
Mailing address:
  • Phone: 850-652-3411
  • Fax: 850-652-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number1312656
License Number StateFL

VIII. Authorized Official

Name: MS. BARBARA R WILLIAMS
Title or Position: CFO
Credential:
Phone: 850-652-3411