Provider Demographics
NPI:1689835217
Name:EMERALD MEDICAL CENTER PLC
Entity Type:Organization
Organization Name:EMERALD MEDICAL CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:G
Authorized Official - Last Name:COY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-543-6555
Mailing Address - Street 1:114 W HARRIS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-2311
Mailing Address - Country:US
Mailing Address - Phone:517-543-6555
Mailing Address - Fax:517-543-6855
Practice Address - Street 1:114 W HARRIS ST
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-2311
Practice Address - Country:US
Practice Address - Phone:517-543-6555
Practice Address - Fax:517-543-6855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076589207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty