| Organization Name: | COASTAL COMPLETE CARE, PA |
| NPI Number: | 1720483043 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RONALD EMERICK (PART OWNER/D.O.) |
| Mailing Address: | 100 Plantation Rd Perry |
| State: | FL US |
| Postal Code: | 323486000 |
| Phone Number: | 8505846000 |
| Fax Number: | |
| NPI Enumeration Date: | 10/29/2014 |
| NPI Last Update Date: | 01/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |