EMERALD COAST NECK & BACK CLINIC, P.A. (NPI# 1386916237) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386916237 |
| Entity Type | Organization |
| Organization Name | EMERALD COAST NECK & BACK CLINIC, P.A. |
| Practice Address |
1003 College Blvd W Suite 4 Niceville FL 32578-1068 |
| Practice Telephone | 8502796485 |
| Practice Fax Number | 8502796546 |
| Mailing Telephone | 8502796485 |
| Mailing Fax Number | 8502796546 |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2012-12-07 |
| Authorized Official Name | CHRISTO W. KOULISIS (PRESIDENT) |
| Authorized Official Telephone | 8502796485 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | ME0053933 | FL | Allopathic & Osteopathic Physicians |
| Y | 207XS0117X |
Orthopaedic Surgery Specialization: Orthopaedic Surgery of the Spine |
ME0053933 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BLUE CROSS BLUE SHIELD | 07915 | 01 |
| FL | 256355000 | 05 | |
| FL | DEPARTMENT OF LABOR | 162510700 | 01 |
| Street Address |
1003 COLLEGE BLVD W SUITE 4 |
| City | NICEVILLE |
| State | FL |
| Zip Code | 32578-1068 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780673749 | Christo W Koulisis | Specialist | 1003 College Blvd W, Suite 4, Niceville, FL 32578-1068 | 2005-10-20 |
| 1255733986 | Brenda K Moore Do Pa | Clinic/Center | 1003 College Blvd W, Suite #2, Niceville, FL 32578-1068 | 2014-09-25 |
| 1275824120 | Brenda Kay Moore | Family Medicine | 1003 College Blvd W, Suite #2, Niceville, FL 32578-1068 | 2011-04-27 |
| 1023349040 | Cory Marcus Scott | Physical Therapist | 1003 College Blvd W, Suite 1, Niceville, FL 32578-1068 | 2010-01-15 |
| 1346412632 | Deborah Lynne Hewitt | Nurse Practitioner | 1003 College Blvd W, Niceville, FL 32578-1068 | 2008-03-27 |
| 1487624201 | Wayne P Justice | Family Medicine | 1003 College Blvd W, Ste 2, Niceville, FL 32578-1068 | 2006-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376028563 | Southern Breeze Healthcare | Family Medicine | 4556 E Hwy 20, Suite 105, Niceville, FL 32578 | 2018-10-03 |
| 1497252860 | Molly Marie Everitt | Physician Assistant | 2190 Fl-85 N, Niceville, FL 32578 | 2018-04-11 |
| 1972009314 | Alexis Aust | Student in an Organized Health Care Education/Training Program | 104 Arrowhead Way, Niceville, FL 32578 | 2018-04-04 |
| 1518488949 | Michelle Sasala | Nurse Practitioner | 4550 E Highway 20, Niceville, FL 32578 | 2017-07-06 |
| 1003336199 | Comfortable Care Denta Health Professionals, Pa | Dentist | 1386 E John Sims Parkway, Niceville, FL 32578 | 2017-06-21 |
| 1306223888 | Emerald Coast Periodontics | Dentist | 719 Bayshore Drive, Niceville, FL 32578 | 2015-05-04 |
| 1538586136 | Pamela Ottesen Dmd LLC | Dentist | 1536 John Sims Pkwy, Niceville, FL 32578 | 2014-03-21 |
| 1417204066 | Mary Jo Stiles | Hearing Instrument Specialist | 4400 Hwy, 20 East, Suite # 211, Niceville, FL 32578 | 2012-08-13 |
| 1093086563 | Pat T. Tidwell Md Pa | Clinic/Center | 4554 Highway 20 East, Niceville, FL 32578 | 2012-01-16 |
| 1952683260 | Gentle Birth Options, LLC | Nurse Practitioner | 296 Bayshore Drive, Niceville, FL 32578 | 2011-09-13 |
| Find all providers in zip 32578 | ||||
| Taxonomy Code | 207XS0117X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Orthopaedic Surgery of the Spine |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with the evaluation and nonoperative and operative treatment of the full spectrum of primary spinal disorders including trauma, degenerative, deformity, tumor, and reconstructive. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386293215 | Citrus Spine Institute LLC | Orthopaedic Surgery | 1409 Kingsley Ave Ste 9f, Orange Park, FL 32073-4579 | 2019-09-04 |
| 1194383638 | Ortho Florida, LLC | Orthopaedic Surgery | 8190 S Jog Rd Ste 101, Boynton Beach, FL 33472-2911 | 2019-05-30 |
| 1821571175 | Orthopedic Spine Solutions Corp | Orthopaedic Surgery | 3852 Sheridan St, Hollywood, FL 33021-3634 | 2018-09-12 |
| 1194223461 | Select Health of Fl, LLC | Orthopaedic Surgery | 2 S Biscayne Blvd Ste 3760a, Miami, FL 33131-1815 | 2018-01-31 |
| 1568960839 | Spine Cin of Jacksonville LLC | Orthopaedic Surgery | 1301 Riverplace Blvd Ste 800a, Jacksonville, FL 32207-9047 | 2018-01-31 |
| 1912405283 | Spine Cin of Naples LLC | Orthopaedic Surgery | 8831 Business Park Dr Ste 301a, Fort Myers, FL 33912-2510 | 2018-01-31 |
| 1386142644 | Joint Replacement Cin of Naples LLC | Orthopaedic Surgery | 8831 Business Park Dr Ste 301b, Fort Myers, FL 33912-2510 | 2018-01-31 |
| 1366940140 | Joint Replacement Cin of Orlando LLC | Orthopaedic Surgery | 5401 S Kirkman Rd Ste 310b, Orlando, FL 32819-7940 | 2018-01-26 |
| 1811495690 | Joint Replacement Cin of Miami LLC | Orthopaedic Surgery | 2 S Biscayne Blvd Ste 3760b, Miami, FL 33131-1815 | 2018-01-26 |
| 1689182362 | Fss Keys LLC | Orthopaedic Surgery | 1111 12th St Ste 108, Key West, FL 33040-4087 | 2018-01-17 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on EMERALD COAST NECK & BACK CLINIC, P.A..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.