MEDICARE: PENSACOLA NEPHROLOGY, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	CF9776	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0358	OTHER	FL	MED3000/HEALTH 1ST NETWOR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	99659	OTHER	FL	BCBS OF FLORIDA
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467495424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENSACOLA NEPHROLOGY, PA

Provider Business Mailing Address
First Line	:	PO BOX 11037
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32524-1037
Country	:	US
Telephone Number	:	850-444-7000
Fax Number	:	850-444-8144

Provider Business Practice Location Address
First Line	:	5149 N 9TH AVE
Second Line	:	SUITE G35
City	:	PENSACOLA
State	:	FL
Zip	:	32504-8756
Country	:	US
Telephone Number	:	850-471-1445
Fax Number	:	850-471-9705

Authorized Official
Title or Position	:	CFO
Name	:	JUSTIN DANSBY
Credential	:
Telephone Number	:	850-444-4700

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	02/19/2025

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