1659308468 NPI number — EMERALD COAST WOMEN'S CENTER, P.L.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659308468 NPI number — EMERALD COAST WOMEN'S CENTER, P.L.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERALD COAST WOMEN'S CENTER, P.L.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659308468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 REDSTONE AVE W
Provider Second Line Business Mailing Address:
SUITE 470
Provider Business Mailing Address City Name:
CRESTVIEW
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32536-6428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-689-2223
Provider Business Mailing Address Fax Number:
850-689-2204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 REDSTONE AVE W
Provider Second Line Business Practice Location Address:
SUITE 470
Provider Business Practice Location Address City Name:
CRESTVIEW
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32536-6428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-689-2223
Provider Business Practice Location Address Fax Number:
850-689-2204
Provider Enumeration Date:
06/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JORDAN
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
850-689-2223

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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