Emerald Coast Urgent Care LLC
Organization Active NPI Urgent Care Clinic/Center · Destin, FL
NPI 1396865556 · NPPES record last updated Feb 21, 2023
Key facts
- NPI
- 1396865556
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Urgent Care Clinic/Center 261QU0200X
- Legal business name
- EMERALD COAST URGENT CARE LLC
- Practice address
- 12598 Highway 98
Suite 101
Destin, FL 32552 - Phone
- (850) 654-8878
- Fax
- (850) 654-8840
- NPI assigned
- Mar 30, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Timothy Paul Nichols, M.D.
- Title
- Owner President
- Phone
- (225) 933-2044
Practitioners 18
-
Cassidi Leanne Albert-Smith, APRC-C
-
Debroh Lynn Bailey, ARNP
-
Marla Gail Denecke, ARNP
-
Zachary William Dickson, ARNP-C
-
Rachel Dowis, APRN
-
Thomas Albert Jacobson, M.D.
-
Timothy P Nichols, M.D.
-
Jennifer Dawn Roberts, APRN
-
Savannah West, APRN
-
Cindy Maeno Caldwell, FNP-C
-
Rylee Holland, PA-C
-
Sybille Moore, PA-C
-
Sherry T Ward, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071030000310 | FL | Part B Supplier - Clinic/Group Practice | 8224125869 |
Receives reassigned benefits from 17 practitioners Practice locations: Destin, FL; Inlet Beach, FL; Panama City Beach, FL |
National Provider Directory
Locations
12598 US Highway 98 W
Unit 101
Miramar Beach, FL 32550
Phone (850) 654-8878
2704 Navy Blvd
Panama City, FL 32408
13625 E Emerald Coast Pkwy
Rosemary Beach, FL 32461
Phone (850) 588-1843
Interoperability endpoints
- https://api.platform.athenahealth.com/1941/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urgent Care Clinic/Center | 261QU0200X | Yes |
Addresses
Primary practice location
12598 Highway 98
Suite 101
Destin, FL 32552
Mailing address
4520 Jamestown Ave Ste 3
Baton Rouge, LA 70808-3214
Phone (225) 706-3033
Other providers in Destin, FL
- Emerald Coast Emergency Physicians LLP
- Emerald Coast Infectious Diseases Medical Group, P.a.
- Emerald Coast Physical Therapy LLC
- Emerald Coast Psychology LLC
- Emerald Coast Radiation Oncology
- Emerald Coast Vision Center
- Amber Leigh Engelsma
- George England
- Lawrence Scott Ennis
- Express Pensacola HHA, Inc.
All providers in Destin, FL · Urgent Care Clinic/Center in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.