Organization
EMERALD COAST NECK & BACK CLINIC, P.A.
Active
Organization
EMERALD COAST NECK & BACK CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTO W. KOULISIS M.D. (PRESIDENT)
(850) 279-6485
Entity
Organization
Contact information
Practice address
1003 COLLEGE BLVD W, SUITE 4, NICEVILLE, FL 32578-1068
(850) 279-6485
(850) 279-6546
Mailing address
1003 COLLEGE BLVD W, SUITE 4, NICEVILLE, FL 32578-1068
(850) 279-6485
(850) 279-6546
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
ME0053933
FL
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
ME0053933
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07915
BLUE CROSS BLUE SHIELD
FL
01
—
162510700
DEPARTMENT OF LABOR
FL
05
—
256355000
—
FL
Enumeration date
02/07/2012
Last updated
12/29/2022
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