Provider Demographics
NPI:1558160267
Name:EMERALD COAST INFECTIOUS DISEASES MEDICAL GROUP, P.A.
Entity type:Organization
Organization Name:EMERALD COAST INFECTIOUS DISEASES MEDICAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-862-3979
Mailing Address - Street 1:917 MAR WALT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6651
Mailing Address - Country:US
Mailing Address - Phone:850-862-3979
Mailing Address - Fax:
Practice Address - Street 1:1921 E NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7747
Practice Address - Country:US
Practice Address - Phone:850-999-5837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment