MEDICARE: EMERALD COAST EMERGENCY PHYSICIANS LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	72205	OTHER	FL	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396980926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERALD COAST EMERGENCY PHYSICIANS LLP

Provider Business Mailing Address
First Line	:	PO BOX 602162
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2162
Country	:	US
Telephone Number	:	866-916-5259
Fax Number	:	231-922-4030

Provider Business Practice Location Address
First Line	:	996 AIRPORT RD
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2824
Country	:	US
Telephone Number	:	850-837-9194
Fax Number	:

Authorized Official
Title or Position	:	LLP MANAGING PARTNER
Name	:	DR. DERIK K KING
Credential	:	MD
Telephone Number	:	866-916-5259

Provider Enumeration Date	:	12/11/2008
Last Update Date	:	09/21/2009

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