Emerald Coast Bone Densitometry

Primary specialty

Body Imaging PhysicianTaxonomy code 2085B0100X

License

ME0063572 Issued in FL

Legal business name

EMERALD COAST BONE DENSITOMETRY

Practice address

417 Racetrack Rd NW # B
Fort Walton Beach, FL 32547-4612

Phone

(850) 864-2663

NPI assigned

Jul 25, 2006

Last updated

Oct 11, 2007By 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

Micki Glenn

Title

Office Manager

Phone

(850) 864-2663

Specialties & licenses 1

Addresses

Tax ID family

Coastal Orthopedic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Coastal Orthopedic

  • Orthopaedic Surgery Physician
  • Niceville, FL
  • NPI 1346277860
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• James Michael Glenn, M.D.

  • Orthopaedic Surgery Physician
  • Green Bay, WI
  • NPI 1336143320
  NPD (past)

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192060800000",
    "number": "1407878408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 RACETRACK RD NW # B",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325474612",
            "telephone_number": "850-864-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 RACETRACK RD NW # B",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325474612",
            "telephone_number": "850-864-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD COAST BONE DENSITOMETRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-10-11",
        "status": "A",
        "authorized_official_last_name": "GLENN",
        "authorized_official_first_name": "MICKI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "850-864-2663"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "FL",
            "license": "ME0063572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ralph Ellis IV
• Jasmyn Ellison, PHARMD
• Kenneth Robert Ellison, PA
• Jolanta H. Emanuel, PT
• Emerald Coast Audiology PA
• Emerald Coast Dentistry
• Emerald Coast Diabetes & Nutrition Center
• Emerald Coast Ear, Nose, Throat & Allergies, P.a.
• Emerald Coast Emergency Physicians LLP
• Emerald Coast Eye Institute LLC

• Body Imaging Physician in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Body Imaging Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; 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.