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General NPI Number Information
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NPI Number | 1407848211
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN OSTEOPOROSIS SERVICES INC
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4511 N DAVIS HWY SUITE 1-C
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City | PENSACOLA
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State | FL
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Zip | 32503-2720
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Country | US
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Telephone | 850-477-0775
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Fax |
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Provider Business Mailing Address
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Address Line | 4511 N DAVIS HWY SUITE 1-C
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City | PENSACOLA
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State | FL
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Zip | 32503-2720
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Country | US
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Telephone | 850-477-0775
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEPHEN D BAST
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Credential | P.A.-C.
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Telephone | 850-477-0775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471B0102X
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Taxonomy Name | Bone Densitometry Radiologic Technologist
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License Number | JR3419100
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License Number State | FL
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