Provider Demographics
NPI:1821675349
Name:EMERALD COAST DURABLE MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:EMERALD COAST DURABLE MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:LURIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-410-4332
Mailing Address - Street 1:347 PINE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4209
Mailing Address - Country:US
Mailing Address - Phone:205-410-4332
Mailing Address - Fax:
Practice Address - Street 1:20 W POINT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-5562
Practice Address - Country:US
Practice Address - Phone:205-410-4332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies