Provider Demographics
NPI:1659308468
Name:EMERALD COAST WOMEN'S CENTER, P.L.
Entity Type:Organization
Organization Name:EMERALD COAST WOMEN'S CENTER, P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-689-2223
Mailing Address - Street 1:550 REDSTONE AVE W
Mailing Address - Street 2:SUITE 470
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-6428
Mailing Address - Country:US
Mailing Address - Phone:850-689-2223
Mailing Address - Fax:850-689-2204
Practice Address - Street 1:550 REDSTONE AVE W
Practice Address - Street 2:SUITE 470
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-6428
Practice Address - Country:US
Practice Address - Phone:850-689-2223
Practice Address - Fax:850-689-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherFED TAX IDENTIFICATION
FL=========OtherFED TAX IDENTIFICATION