Surfside Family Medicine LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

ME94076 Issued in FL

Legal business name

SURFSIDE FAMILY MEDICINE LLC

Practice address

3000 N Atlantic Ave Ste 108
Cocoa Beach, FL 32931-5029

Phone

(321) 799-2554

Fax

(321) 799-4750

NPI assigned

Aug 19, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Olga Dorjima Emgushov, MD

Title

Owner/Physician

Phone

(321) 799-2554

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1250640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250640000000",
    "number": "1801028246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 N ATLANTIC AVE STE 108",
            "city": "COCOA BEACH",
            "state": "FL",
            "postal_code": "329315029",
            "telephone_number": "321-799-2554",
            "fax_number": "321-799-4750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 N ATLANTIC AVE STE 108",
            "city": "COCOA BEACH",
            "state": "FL",
            "postal_code": "329315029",
            "telephone_number": "321-799-2554",
            "fax_number": "321-799-4750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURFSIDE FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-19",
        "last_updated": "2009-08-19",
        "status": "A",
        "authorized_official_last_name": "EMGUSHOV",
        "authorized_official_first_name": "OLGA",
        "authorized_official_middle_name": "DORJIMA",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "321-799-2554",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "ME94076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara Wooden Stickle, LMT
• Ellwood Herbert Stoddard, RPH
• Lori Jean Stottler, LMHC
• Sunshine Healthcare Solutions Inc
• Sunshine Healthcare Solutions of Brevard LLC
• Surfside Family Practice LLC
• Surgical Specialists of Central Brevard PA
• Joseph C Sutly
• Amy Swan, AGNP-C
• Synergistic Resonance LLC

• Primary Care Clinic/Center in Cocoa Beach, FL
• Providers in Cocoa Beach, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.