Provider Demographics
NPI:1679097679
Name:HEALTHPOINT MEDICAL GROUP OF THE EMERALD COAST, LLC
Entity Type:Organization
Organization Name:HEALTHPOINT MEDICAL GROUP OF THE EMERALD COAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-233-2323
Mailing Address - Street 1:12234 PANAMA CITY BEACH PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2726
Mailing Address - Country:US
Mailing Address - Phone:850-233-2323
Mailing Address - Fax:
Practice Address - Street 1:12234 PANAMA CITY BEACH PKWY STE C
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2726
Practice Address - Country:US
Practice Address - Phone:850-233-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
58926YOtherMEDICARE PTAN