Provider Demographics
NPI:1083098388
Name:COASTAL COMPLETE CARE
Entity Type:Organization
Organization Name:COASTAL COMPLETE CARE
Other - Org Name:PRIMARY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER, MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:EMERICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:850-584-6000
Mailing Address - Street 1:100 PLANTATION RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32348-6000
Mailing Address - Country:US
Mailing Address - Phone:850-584-6000
Mailing Address - Fax:850-584-6001
Practice Address - Street 1:1706 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32348-5611
Practice Address - Country:US
Practice Address - Phone:850-584-6000
Practice Address - Fax:850-584-6001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL COMPLETE CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9746261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care