Emerald Coast Surgical Specialists PA

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

EMERALD COAST SURGICAL SPECIALISTS PA

Practice address

5992 Berryhill Road
203
Milton, FL 32570

Phone

(850) 626-2131

Fax

(850) 626-2133

NPI assigned

Dec 27, 2007

Organization subpart

No

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

Authorized official

Name

Randall L McKissack, MD

Title

Owner/Physician

Phone

(850) 626-2131

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212105600000",
    "number": "1750565768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30215",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325031215",
            "telephone_number": "850-626-2131",
            "fax_number": "850-626-2133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5992 BERRYHILL ROAD",
            "address_2": "203",
            "city": "MILTON",
            "state": "FL",
            "postal_code": "32570",
            "telephone_number": "850-626-2131",
            "fax_number": "850-626-2133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD COAST SURGICAL SPECIALISTS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2008-05-30",
        "status": "A",
        "authorized_official_last_name": "MCKISSACK",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "850-626-2131",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "277632400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Theresa Edwards, BCBA
• Makenzie Elliott
• Makayla Brynn Ellison
• Emerald Coast City of Hope, Inc
• Emerald Coast Pediatrics P.a.
• Emily F Winfree, LCSW LLC
• Escambia Community Clinics, Inc (Milton)
• Escambia Community Clinics, Inc
• F & M of Milton Inc (Joslin Family Eyecare)
• Allyssa Faughnan

• Surgery Physician in Milton, FL
• Providers in Milton, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2008; 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.