Healthcare Provider Details

I. General information

NPI: 1942344106
Provider Name (Legal Business Name): SOUTHEAST ASSOCIATION OF HEALTHCARE PROVIDERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 N DAVIS HWY
PENSACOLA FL
32503-2006
US

IV. Provider business mailing address

5330 N DAVIS HWY
PENSACOLA FL
32503-2006
US

V. Phone/Fax

Practice location:
  • Phone: 850-477-8874
  • Fax: 850-477-8865
Mailing address:
  • Phone: 850-477-8874
  • Fax: 850-477-8865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH6343
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH6348
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8124
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME92143
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4977
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PHILIP E. RENFROE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 850-477-8874