Emerald Coast Regen, PA

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

EMERALD COAST REGEN, PA

Practice address

1008 Jenks Ave
Panama City, FL 32401-2437

Phone

(850) 814-7686

NPI assigned

May 20, 2020

Organization subpart

No

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

Authorized official

Name

Wesley Johnson

Title

President

Phone

(850) 814-7686

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1589932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589932800000",
    "number": "1407479835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 JENKS AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324012437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 JENKS AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324012437",
            "telephone_number": "850-814-7686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD COAST REGEN, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-20",
        "last_updated": "2020-05-20",
        "certification_date": "2020-05-20",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-814-7686"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emerald Coast Medical Transport, Inc.
• Emerald Coast OBGYN, Inc
• Emerald Coast Obstetrics & Gynecology, P.a.
• Emerald Coast Orthopedics PLLC
• Emerald Coast Pediatrics & Adolescents
• Emerald Coast Sleep Diagnostics
• Emerald Coast Sleep Diagnostics
• Emerald Coast Ventures Inc (The Good Feet Store)
• Emerald Isle Pulmonary Medicine Inc
• Emerald Waters Inpatient Services LLC

• Health Service Clinic/Center in Panama City, FL
• Providers in Panama City, FL by specialty
• Health Service Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; 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.