1598712770 NPI number — EMERALD COAST OBGYN, INC

Table of content: JOANNA LYNN DARROW PTA (NPI 1720710189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598712770 NPI number — EMERALD COAST OBGYN, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERALD COAST OBGYN, 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:
6
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:
1598712770
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 E 23RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PANAMA CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32405-4501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-769-0338
Provider Business Mailing Address Fax Number:
850-785-6088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 E 23RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PANAMA CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32405-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-769-0338
Provider Business Practice Location Address Fax Number:
850-785-6088
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COX
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
850-769-0338

Provider Taxonomy Codes

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

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

  • Identifier: 373548600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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