Provider Demographics
NPI:1912384645
Name:EMERALD COAST SERVICES, LLC
Entity Type:Organization
Organization Name:EMERALD COAST SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-423-1024
Mailing Address - Street 1:PO BOX 6113
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-0113
Mailing Address - Country:US
Mailing Address - Phone:502-423-1024
Mailing Address - Fax:
Practice Address - Street 1:24525 SOUTHFIELD RD
Practice Address - Street 2:SUITE 209
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2740
Practice Address - Country:US
Practice Address - Phone:248-234-8897
Practice Address - Fax:888-392-6043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory