Provider Demographics
NPI:1396865556
Name:EMERALD COAST URGENT CARE LLC
Entity type:Organization
Organization Name:EMERALD COAST URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-933-2044
Mailing Address - Street 1:4520 JAMESTOWN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3214
Mailing Address - Country:US
Mailing Address - Phone:225-706-3033
Mailing Address - Fax:225-218-4888
Practice Address - Street 1:12598 HIGHWAY 98
Practice Address - Street 2:SUITE 101
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32552
Practice Address - Country:US
Practice Address - Phone:850-654-8878
Practice Address - Fax:850-654-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care