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General NPI Number Information
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NPI Number | 1912384645
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Entity Type | Organization
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Legal Business Name | EMERALD COAST SERVICES, LLC
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 05/01/2015
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Provider Practice Location Address
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Address Line | 24525 SOUTHFIELD RD SUITE 209
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2740
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Country | US
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Telephone | 248-234-8897
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Fax | 888-392-6043
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Provider Business Mailing Address
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Address Line | PO BOX 6113
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City | LOUISVILLE
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State | KY
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Zip | 40206-0113
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Country | US
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Telephone | 502-423-1024
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. CHRISTOPHER L. NELSON
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Credential | M.D.
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Telephone | 502-423-1024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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