Provider Demographics
NPI:1437114378
Name:EMERALD COAST SURGERY CENTER, LP
Entity Type:Organization
Organization Name:EMERALD COAST SURGERY CENTER, LP
Other - Org Name:EMERALD COAST SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KACHELHOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-863-8165
Mailing Address - Street 1:995 MAR WALT DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547
Mailing Address - Country:US
Mailing Address - Phone:850-863-7887
Mailing Address - Fax:850-863-6645
Practice Address - Street 1:995 MAR WALT DRIVE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-863-7887
Practice Address - Fax:850-863-6645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
FL996261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0791423Medicaid
FLF1189Medicare PIN
490002287Medicare PIN