GENESISCARE USA OF FLORIDA LLC (NPI# 1174768477) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174768477 |
| Entity Type | Organization |
| Organization Name | GENESISCARE USA OF FLORIDA LLC |
| Other Organization Name | EMERALD COAST UROLOGY |
| Practice Address |
909 Mar Walt Dr Suite 1011 Fort Walton Beach FL 32547-6635 |
| Mailing Address |
2160 Colonial Blvd Fort Myers FL 33907-1410 |
| Practice Telephone | 8506833377 |
| Mailing Telephone | 2399317342 |
| Mailing Fax Number | 2399317385 |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2020-08-24 |
| Authorized Official Name | DAN COLLINS (PRESIDENT) |
| Authorized Official Telephone | 2399317275 |
| Is Organization Subpart | Y |
| Parent Organization Name | GENESISCARE USA INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Emerald Coast Urology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336509546 | Genesiscare Usa of Florida LLC | Surgery | 550 Twin Cities Blvd Ste C, Niceville, FL 32578-1050 | 2016-03-01 |
| 1528423670 | Genesiscare Usa of Florida LLC | Pharmacy | 2234 Colonial Blvd Ste 110, Fort Myers, FL 33907 | 2015-12-16 |
| 1982079380 | Genesiscare Usa of Florida LLC | Surgery | 820 Goodlette-frank Rd N, Naples, FL 34102-5445 | 2015-12-10 |
| 1184095234 | Genesiscare Usa of Florida LLC | Urology | 5065 S State Road 7 Ste 203, Lake Worth, FL 33449-5439 | 2015-10-15 |
| 1770952616 | Genesiscare Usa of Florida LLC | Urology | 3361 South Miami Avenue, Suite 306, Miami, FL 33133-4232 | 2015-09-22 |
| 1659755783 | Genesiscare Usa of Florida LLC | Surgery | 8925 Colonial Center Dr Ste 2000, Fort Myers, FL 33905-7813 | 2015-07-18 |
| 1174915748 | Genesiscare Usa of Florida LLC | Urology | 2721 Del Prado Blvd S Ste 230b, Cape Coral, FL 33904-5993 | 2015-02-19 |
| 1891036810 | Genesiscare Usa of Florida LLC | Surgery | 13691 Metro Pkwy Ste 350, Metro Medical Plaza, Fort Myers, FL 33912-4351 | 2013-03-15 |
| 1871735480 | Genesiscare Usa of Florida LLC | Urology | 2150 S Andrews Ave Ste 100, Fort Lauderdale, FL 33316-3432 | 2009-03-27 |
| 1972796787 | Genesiscare Usa of Florida LLC | Surgery | 1311 N University Dr, Coral Springs, FL 33071-6622 | 2007-08-24 |
| Street Address |
909 MAR WALT DR SUITE 1011 |
| City | FORT WALTON BEACH |
| State | FL |
| Zip Code | 32547-6635 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356317002 | Robert Lawrence Long | Urology | 909 Mar Walt Dr, Suite 1011, Fort Walton Beach, FL 32547-6635 | 2006-02-23 |
| 1891729026 | Emerald Coast Urology | Urology | 909 Mar Walt Dr, Suite 1011, Fort Walton Beach, FL 32547-6635 | 2006-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255944955 | Theresa Ann Morvay | Behavior Technician | 419 Racetrack Rd Ne, Fort Walton Beach, FL 32547 | 2020-08-24 |
| 1588295422 | Emily Ann Glossop | Nurse Practitioner | 930 Mar Walt Drive C, Fort Walton Beach, FL 32547 | 2020-01-29 |
| 1225669443 | Elizabeth Rogers Nagengast | Physician Assistant | 930 Mar Walt Drive, Unit C, Fort Walton Beach, FL 32547 | 2020-01-27 |
| 1497254791 | Carmen Alston | Nurse Practitioner | 930 Mar Walt Dr C, Fort Walton Beach, FL 32547 | 2018-02-02 |
| 1871004960 | Center for Neuropsychological Services Cns | Clinical Neuropsychologist | 1817 Lewis Turner Blvd, Fort Walton Beach, FL 32547 | 2017-10-17 |
| 1194235648 | Robin Wray | Speech-Language Pathologist | 930 Mar Walt Dr D, Fort Walton Beach, FL 32547 | 2017-10-10 |
| 1285007989 | Dynamic Pain & Wellness Pllc | Pain Medicine | 930 Marwalt Drive, Suite B and C, Fort Walton Beach, FL 32547 | 2015-11-04 |
| 1013392810 | Terry Abbott | Social Worker | 648 Overbrook Dr, Fort Walton Beach, FL 32547 | 2015-07-22 |
| 1083024673 | Emily Lohr | Physical Therapy Assistant | 2000 Principle Ln, Ft. Walton Beach, FL 32547 | 2014-05-05 |
| 1831526102 | Laurie Ann Schweppe | Nurse Practitioner | 1005 Mar Walt Drivve, Snf Hospitalist Department, Fort Walton Beach, FL 32547 | 2013-10-02 |
| Find all providers in zip 32547 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598975641 | Christopher L Allam | Urology | 341 Racetrack Rd Nw, Suite B, Fort Walton Beach, FL 32547-1552 | 2007-05-23 |
| 1205804432 | Okaloosa Walton Urology Pa | Urology | 1112 Hospital Rd, Unit A, Fort Walton Beach, FL 32547-6655 | 2006-03-14 |
| 1356317002 | Robert Lawrence Long | Urology | 909 Mar Walt Dr, Suite 1011, Fort Walton Beach, FL 32547-6635 | 2006-02-23 |
| 1306234174 | 21st Century Oncology LLC | Urology | 914b Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2015-01-02 |
| 1427339399 | Genesiscare Usa of Florida LLC | Urology | 914 Mar Walt Dr, Suite B, Fort Walton Beach, FL 32547-6706 | 2011-09-06 |
| 1144519018 | Beibei Oelrich | Urology | 1032 Mar Walt Dr Unit 250, Fort Walton Beach, FL 32547 | 2011-03-31 |
| 1235326026 | Basil D. Fossum, M.d.,f.a.c.s | Urology | 914b Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2007-09-26 |
| 1891729026 | Emerald Coast Urology | Urology | 909 Mar Walt Dr, Suite 1011, Fort Walton Beach, FL 32547-6635 | 2006-07-11 |
| 1851331474 | John R Burns | Urology | 914b Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2006-06-08 |
| 1013957240 | William F Stiles IIi | Urology | 1032 Mar Walt Drive, Suite 250, Fort Walton Beach, FL 32547 | 2006-06-07 |
| Find all providers in FORT WALTON BEACH | ||||
| City | FORT WALTON BEACH |
| Zip Code | 32547 |
Please comment or provide details below to improve the information on GENESISCARE USA OF FLORIDA LLC.
| 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.