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General NPI Number Information
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NPI Number | 1821675349
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Entity Type | Organization
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Legal Business Name | EMERALD COAST DURABLE MEDICAL EQUIPMENT, LLC
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 20 W POINT WASHINGTON RD
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-5562
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Country | US
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Telephone | 205-410-4332
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Fax |
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Provider Business Mailing Address
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Address Line | 347 PINE GROVE RD
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City | ROSWELL
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State | GA
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Zip | 30075-4209
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Country | US
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Telephone | 205-410-4332
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. ADAM IVAN LURIE
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Credential |
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Telephone | 205-410-4332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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