Provider Demographics
NPI:1699180315
Name:EMERALD SANDS MEDICAL CENTER
Entity Type:Organization
Organization Name:EMERALD SANDS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKMASTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-955-1600
Mailing Address - Street 1:8158 US HWY 59
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535
Mailing Address - Country:US
Mailing Address - Phone:251-955-1600
Mailing Address - Fax:
Practice Address - Street 1:8158 US HWY 59
Practice Address - Street 2:SUITE 107
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535
Practice Address - Country:US
Practice Address - Phone:251-955-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20768261QP2300X
AL1-131772261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL106106Medicaid
AL106106Medicaid