1144548793 NPI number — EMERALD COAST HOSPITALIST INC

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 1144548793 NPI number — EMERALD COAST HOSPITALIST INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERALD COAST HOSPITALIST INC
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:
1144548793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
653 W 23RD ST
Provider Second Line Business Mailing Address:
UNIT/PMB 244
Provider Business Mailing Address City Name:
PANAMA CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32405-3922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-215-2337
Provider Business Mailing Address Fax Number:
850-215-2844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
653 W 23RD ST
Provider Second Line Business Practice Location Address:
UNIT/PMB 244
Provider Business Practice Location Address City Name:
PANAMA CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32405-3922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-215-2337
Provider Business Practice Location Address Fax Number:
850-215-2844
Provider Enumeration Date:
05/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DAO
Authorized Official First Name:
HEIN
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
850-585-5753

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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