Provider Demographics
NPI:1497134068
Name:EMERALD COAST MEDICAL MANAGEMENT PLLC
Entity Type:Organization
Organization Name:EMERALD COAST MEDICAL MANAGEMENT PLLC
Other - Org Name:EMERALD COAST REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-423-1021
Mailing Address - Street 1:42 BUSINESS CENTRE DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-6920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:42 BUSINESS CENTRE DR
Practice Address - Street 2:SUITE 308
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-6920
Practice Address - Country:US
Practice Address - Phone:850-460-8778
Practice Address - Fax:850-460-8779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123663208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty