Healthcare Provider Details

I. General information

NPI: 1609431493
Provider Name (Legal Business Name): CHILDREN'S ORTHOPAEDIC INSTITUTE OF NORTHWEST FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 HOSPITAL DR
CRESTVIEW FL
32539-7380
US

IV. Provider business mailing address

1910 E BLOUNT ST
PENSACOLA FL
32503-6126
US

V. Phone/Fax

Practice location:
  • Phone: 850-356-2467
  • Fax:
Mailing address:
  • Phone: 850-356-2467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT PO-CHEN HUANG
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 850-356-2467