Provider Demographics
NPI:1346015864
Name:EMERALD COAST NON-EMERGENCY TRANSPORT LLC
Entity Type:Organization
Organization Name:EMERALD COAST NON-EMERGENCY TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-966-2290
Mailing Address - Street 1:755 GRAND BLVD # 105B-333
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-1838
Mailing Address - Country:US
Mailing Address - Phone:404-966-2290
Mailing Address - Fax:
Practice Address - Street 1:79 SCENIC GULF DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-4938
Practice Address - Country:US
Practice Address - Phone:770-869-5472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)