MEDICARE: BERRYHILL ORTHOPAEDICS, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME0044109	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	57095	OTHER	FL	BCBS FLORIDA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164434031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERRYHILL ORTHOPAEDICS, PA

Provider Business Mailing Address
First Line	:	6007 BERRYHILL RD
Second Line	:
City	:	MILTON
State	:	FL
Zip	:	32570-4008
Country	:	US
Telephone Number	:	850-626-1461
Fax Number	:	850-626-3161

Provider Business Practice Location Address
First Line	:	6007 BERRYHILL RD
Second Line	:
City	:	MILTON
State	:	FL
Zip	:	32570-4008
Country	:	US
Telephone Number	:	850-626-1461
Fax Number	:	850-626-3161

Authorized Official
Title or Position	:	BILLING SPECIALIST
Name	:	MRS. JANEL DAWNETTE SUTTON
Credential	:
Telephone Number	:	850-626-1461

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	08/13/2008

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