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Organization

EMERALD COAST MEDICAL SUPPLIES LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TARA FOSTER (OWNER)
(850) 420-2240
Entity
Organization

Contact information

Practice address
48 BALD EAGLE DR, SANTA ROSA BEACH, FL 32459
(850) 420-2240
Mailing address
48 BALD EAGLE DR, SANTA ROSA BEACH, FL 32459-8342
(850) 420-2240
(850) 344-9758

Taxonomy

Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
7EHGC
FLORIDA BLUE
FL
Enumeration date
04/02/2017
Last updated
09/28/2020
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