Emerald Coast Neonatology PA

Primary specialty

Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X

License

ME66820 Issued in FL

Legal business name

EMERALD COAST NEONATOLOGY PA

Practice address

4250 Hospital Drive
Marianna, FL 32446

Phone

(850) 265-9332

Fax

(850) 784-7706

NPI assigned

Sep 29, 2006

Last updated

Jan 22, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Douglas Sprague, M.D.

Title

President

Phone

(850) 265-9332

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232582400000",
    "number": "1285726091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15789",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "32406",
            "telephone_number": "850-265-9332",
            "fax_number": "850-784-7706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 HOSPITAL DRIVE",
            "city": "MARIANNA",
            "state": "FL",
            "postal_code": "32446",
            "telephone_number": "850-265-9332",
            "fax_number": "850-784-7706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD COAST NEONATOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2009-01-22",
        "status": "A",
        "authorized_official_last_name": "SPRAGUE",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-265-9332",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "FL",
            "license": "ME66820",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FLORIDA",
            "identifier": "45706",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "260912600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Tyler Ellerbee, ARNP
• Rachel Ann Elliott, ARNP
• Taylor Elliott, FNP-C
• Elyssa N Waller
• Emerald Coast Management Solutions LLC
• Eminence Emergency Physicians, LLC
• Endless Empowerment, PLLC
• ER Physician Group at Jackson Hospital
• ER Physician Group at Jackson Hospital (Womens Healthcare of The Panhandle)
• ER Physician Group at Jackson Hospital (Women's Healthcare of the Panhandle)

• Pediatric Critical Care Medicine Physician in Marianna, FL
• Providers in Marianna, FL by specialty
• Pediatric Critical Care Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.