Healthcare Provider Details

I. General information

NPI: 1164434031
Provider Name (Legal Business Name): BERRYHILL ORTHOPAEDICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6007 BERRYHILL RD
MILTON FL
32570-4008
US

IV. Provider business mailing address

6007 BERRYHILL RD
MILTON FL
32570-4008
US

V. Phone/Fax

Practice location:
  • Phone: 850-626-1461
  • Fax: 850-626-3161
Mailing address:
  • Phone: 850-626-1461
  • Fax: 850-626-3161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0044109
License Number StateFL

VIII. Authorized Official

Name: MRS. JANEL DAWNETTE SUTTON
Title or Position: BILLING SPECIALIST
Credential:
Phone: 850-626-1461