Provider Demographics
NPI:1528037942
Name:EMERALD COAST OXYGEN & MEDICAL EQUIPMENT SUPPLY, LLC
Entity Type:Organization
Organization Name:EMERALD COAST OXYGEN & MEDICAL EQUIPMENT SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-652-3411
Mailing Address - Street 1:8189B MILLERS ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32567-2118
Mailing Address - Country:US
Mailing Address - Phone:850-652-3411
Mailing Address - Fax:850-652-2033
Practice Address - Street 1:8189B MILLERS ST
Practice Address - Street 2:
Practice Address - City:LAUREL HILL
Practice Address - State:FL
Practice Address - Zip Code:32567-2118
Practice Address - Country:US
Practice Address - Phone:850-652-3411
Practice Address - Fax:850-652-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312656332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5508780001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT