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General NPI Number Information
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NPI Number | 1730200023
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Entity Type | Organization
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Legal Business Name | CREEKSIDE PSYCHIATRIC CENTER
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5190 BAYOU BLVD STE 6
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City | PENSACOLA
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State | FL
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Zip | 32503-2162
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Country | US
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Telephone | 850-476-0977
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Fax | 850-476-2558
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Provider Business Mailing Address
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Address Line | 5190 BAYOU BLVD STE 6
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City | PENSACOLA
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State | FL
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Zip | 32503-2162
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Country | US
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Telephone | 850-476-0977
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Fax | 850-476-2558
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Authorized Official
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Title or Position | OWNER
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Name | R SCOTT BENSON
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Credential | M.D.
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Telephone | 850-476-0977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | ME26830
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License Number State | FL
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