Provider Demographics
NPI:1588179097
Name:EMERALD MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:EMERALD MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-351-7058
Mailing Address - Street 1:19455 GULF BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:INDIAN SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33785-2000
Mailing Address - Country:US
Mailing Address - Phone:727-351-7058
Mailing Address - Fax:727-509-3073
Practice Address - Street 1:19455 GULF BLVD STE 5
Practice Address - Street 2:
Practice Address - City:INDIAN SHORES
Practice Address - State:FL
Practice Address - Zip Code:33785-2000
Practice Address - Country:US
Practice Address - Phone:727-351-7058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2018-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies