Healthcare Provider Details

I. General information

NPI: 1588646244
Provider Name (Legal Business Name): PENSACOLA ORTHOPAEDICS & SPORTS MEDICINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5147 N 9TH AVE SUITE 322
PENSACOLA FL
32504-8710
US

IV. Provider business mailing address

5147 N 9TH AVE SUITE 322
PENSACOLA FL
32504-8710
US

V. Phone/Fax

Practice location:
  • Phone: 850-474-9995
  • Fax: 850-477-6021
Mailing address:
  • Phone: 850-474-9995
  • Fax: 850-477-6021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. CHARLA TURBERVILLE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 850-474-9995