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General NPI Number Information
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NPI Number | 1033542485
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Entity Type | Organization
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Legal Business Name | EMORY MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 08/22/2013
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Provider Practice Location Address
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Address Line | 1546 S WATER ST STE. A
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City | STARKE
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State | FL
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Zip | 32091-4511
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Country | US
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Telephone | 904-964-4777
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Fax | 904-964-4780
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Provider Business Mailing Address
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Address Line | PO BOX 1646
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City | LAKE CITY
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State | FL
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Zip | 32056-1646
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. AMANDA BOLT
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Credential |
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Telephone | 386-466-1106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2093
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License Number State | FL
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