Provider Demographics
NPI:1144548793
Name:EMERALD COAST HOSPITALIST INC
Entity type:Organization
Organization Name:EMERALD COAST HOSPITALIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:HEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-585-5753
Mailing Address - Street 1:653 W 23RD ST
Mailing Address - Street 2:UNIT/PMB 244
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3922
Mailing Address - Country:US
Mailing Address - Phone:850-215-2337
Mailing Address - Fax:850-215-2844
Practice Address - Street 1:653 W 23RD ST
Practice Address - Street 2:UNIT/PMB 244
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3922
Practice Address - Country:US
Practice Address - Phone:850-215-2337
Practice Address - Fax:850-215-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H11745Medicare UPIN