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General NPI Number Information
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NPI Number | 1760875983
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Entity Type | Organization
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Legal Business Name | BAPTIST MEDICAL PARK SURGERY CENTER, LLC
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 9400 UNIVERSITY PKWY SUITE 102
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City | PENSACOLA
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State | FL
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Zip | 32514-5752
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Country | US
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Telephone | 850-208-6330
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Fax | 850-208-6335
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Provider Business Mailing Address
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Address Line | 9400 UNIVERSITY PKWY SUITE 102
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City | PENSACOLA
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State | FL
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Zip | 32514-5752
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Country | US
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Telephone | 850-208-6330
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Fax | 850-208-6335
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | JOHN PORTER
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Credential | VP
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Telephone | 850-469-2338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 412
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License Number State | FL
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