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General NPI Number Information
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NPI Number | 1306628102
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Entity Type | Organization
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Legal Business Name | BARTOW ENTERPRISES LLC
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 212 W TROY ST STE B
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City | DOTHAN
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State | AL
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Zip | 36303-4455
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Country | US
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Telephone | 954-579-7484
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Fax |
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Provider Business Mailing Address
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Address Line | 20050 OAK RD E UNIT 805
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City | GULF SHORES
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State | AL
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Zip | 36542-5726
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW BARTOW
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Credential | MD
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Telephone | 954-579-7484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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