Organization Name: | COASTAL COMPLETE CARE |
NPI Number: | 1083098388 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RONALD EMERICK (CO-OWNER, MEDICAL DIRECTOR) |
Mailing Address: | 1706 S Jefferson St Perry |
State: | FL US |
Postal Code: | 323485611 |
Phone Number: | 8505846000 |
Fax Number: | 8505846001 |
NPI Enumeration Date: | 07/16/2015 |
NPI Last Update Date: | 07/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | OS9746 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |