Healthcare Provider Details

I. General information

NPI: 1053606335
Provider Name (Legal Business Name): SOUTHERN MEDICAL CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 11/11/2023
Certification Date: 11/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4493 WOODBINE RD STE 3600
PACE FL
32571-8726
US

IV. Provider business mailing address

PO BOX 10444
PENSACOLA FL
32524-0444
US

V. Phone/Fax

Practice location:
  • Phone: 256-460-2021
  • Fax: 540-870-6277
Mailing address:
  • Phone: 256-460-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES F. BENSON JR.
Title or Position: OWNER
Credential: M.D.
Phone: 256-460-2021