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General NPI Number Information
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NPI Number | 1427156827
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Entity Type | Organization
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Legal Business Name | SOUTHERN ORTHOPAEDICS AND SPORTS MEDICINE
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 02/24/2020
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Provider Practice Location Address
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Address Line | 1823 N 9TH AVE STE 534
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City | PENSACOLA
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State | FL
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Zip | 32503-5270
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Country | US
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Telephone | 850-432-3293
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Fax | 850-469-9113
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Provider Business Mailing Address
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Address Line | 1823 N 9TH AVE STE 534
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City | PENSACOLA
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State | FL
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Zip | 32503-5270
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Country | US
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Telephone | 850-432-3293
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Fax | 850-469-9113
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KELLY A RYSULA
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Credential |
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Telephone | 850-432-3293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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