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General NPI Number Information
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NPI Number | 1023540648
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Entity Type | Organization
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Legal Business Name | EMERALD COAST MEDICAL SUPPLIES LLC
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Dates
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Enumeration Date | 04/02/2017
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 48 BALD EAGLE DR
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459
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Country | US
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Telephone | 850-420-2240
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Fax |
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Provider Business Mailing Address
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Address Line | 48 BALD EAGLE DR
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-8342
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Country | US
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Telephone | 850-420-2240
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Fax | 850-344-9758
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Authorized Official
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Title or Position | OWNER
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Name | TARA FOSTER
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Credential |
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Telephone | 850-420-2240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number |
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License Number State |
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