Provider Demographics
NPI:1043238942
Name:OB/GYN SPECIALISTS OF THE EMERALD COAST
Entity Type:Organization
Organization Name:OB/GYN SPECIALISTS OF THE EMERALD COAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMBRUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-862-1800
Mailing Address - Street 1:1110 HOSPITAL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6778
Mailing Address - Country:US
Mailing Address - Phone:850-862-1800
Mailing Address - Fax:
Practice Address - Street 1:1110 HOSPITAL RD
Practice Address - Street 2:SUITE C
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6778
Practice Address - Country:US
Practice Address - Phone:850-862-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77965207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG72623Medicare UPIN