Healthcare Provider Details

I. General information

NPI: 1356286702
Provider Name (Legal Business Name): EMERALD COAST ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MACK BAYOU RD
SANTA ROSA BEACH FL
32459-3101
US

IV. Provider business mailing address

200 MACK BAYOU RD
SANTA ROSA BEACH FL
32459-3101
US

V. Phone/Fax

Practice location:
  • Phone: 469-872-4706
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COLLIN LEMAISTRE
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 214-213-0732