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General NPI Number Information
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NPI Number | 1699770545
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Entity Type | Organization
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Legal Business Name | BIG BEND OPERATIONS
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 555 N BYRON BUTLER PKWY
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City | PERRY
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State | FL
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Zip | 32347-2315
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Country | US
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Telephone | 850-584-2778
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Fax | 850-584-2790
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Provider Business Mailing Address
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Address Line | 555 N BYRON BUTLER PKWY
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City | PERRY
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State | FL
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Zip | 32347-2315
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Country | US
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Telephone | 850-584-2778
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Fax | 850-584-2790
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Authorized Official
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Title or Position | MANAGER EMPLOYEE / CEO
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Name | CHARLES SCOTT KEELER
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Credential |
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Telephone | 850-584-2778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 1076
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License Number State | FL
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