1528037942 NPI number — EMERALD COAST OXYGEN & MEDICAL EQUIPMENT SUPPLY, LLC

Table of content: (NPI 1528037942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528037942 NPI number — EMERALD COAST OXYGEN & MEDICAL EQUIPMENT SUPPLY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERALD COAST OXYGEN & MEDICAL EQUIPMENT SUPPLY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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NPI Number Information

NPI Number:
1528037942
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:
8189B MILLERS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL HILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32567-2118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-652-3411
Provider Business Mailing Address Fax Number:
850-652-2033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8189B MILLERS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL HILL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32567-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-652-3411
Provider Business Practice Location Address Fax Number:
850-652-2033
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
850-652-3411

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  1312656 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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