| Coastline Medical Services Pllc | |
|
1817 Lewis Turner Blvd Ste F Fort Walton Beach FL 32547-1349 | |
| (850) 396-1110 | |
| Not Available |
| Full Name | Coastline Medical Services Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1817 Lewis Turner Blvd Ste F, Fort Walton Beach, Florida |
| Authorized Official Name and Position | Michael Tavernaris (PHYSICIAN) |
| Authorized Official Contact | 8503961110 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastline Medical Services Pllc 208 Mary Esther Blvd Mary Esther FL 32569-1687 Ph: () - | Coastline Medical Services Pllc 1817 Lewis Turner Blvd Ste F Fort Walton Beach FL 32547-1349 Ph: (850) 396-1110 |
| NPI Number | 1003361767 |
|---|---|
| Provider Enumeration Date | 08/23/2016 |
| Last Update Date | 09/27/2024 |
| Medicare PECOS PAC ID | 0143593392 |
|---|---|
| Medicare Enrollment ID | O20170909000031 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003361767 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Secondary |
| 261QM2500X | Clinic/center - Medical Specialty | ME116308 (Florida) | Primary |
| Provider Name | Michael E Tavernaris |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386888626 PECOS PAC ID: 2062654973 Enrollment ID: I20130806000172 |
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