MEDICARE: EMERALD COAST OXYGEN & MEDICAL EQUIPMENT SUPPLY, LLC

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	332BX2000X	Oxygen Equipment & Supplies (DME)	1312656	FL

General Provider Information

NPI Number	:	1528037942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERALD COAST OXYGEN & MEDICAL EQUIPMENT SUPPLY, LLC

Provider Business Mailing Address
First Line	:	8189B MILLERS ST
Second Line	:
City	:	LAUREL HILL
State	:	FL
Zip	:	32567-2118
Country	:	US
Telephone Number	:	850-652-3411
Fax Number	:	850-652-2033

Provider Business Practice Location Address
First Line	:	8189B MILLERS ST
Second Line	:
City	:	LAUREL HILL
State	:	FL
Zip	:	32567-2118
Country	:	US
Telephone Number	:	850-652-3411
Fax Number	:	850-652-2033

Authorized Official
Title or Position	:	CFO
Name	:	MS. BARBARA R WILLIAMS
Credential	:
Telephone Number	:	850-652-3411

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	08/22/2020

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