=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710250048
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR AUTONOMIC DISORDERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2012
-----------------------------------------------------
Last Update Date | 02/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6706 N 9TH AVE SUITE A-3
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32504-9303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-476-8200
-----------------------------------------------------
Fax | 850-476-8282
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6706 N 9TH AVE SUITE A-3
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32504-9303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-476-8200
-----------------------------------------------------
Fax | 850-476-8282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PST
-----------------------------------------------------
Name | CHARLES R THOMPSON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 850-476-8200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | ME 53590
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------