Provider Demographics
NPI:1043430739
Name:BAPTIST PHYSICIAN PARTNERS LLC
Entity Type:Organization
Organization Name:BAPTIST PHYSICIAN PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPCS,CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CREECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-475-3726
Mailing Address - Street 1:PO BOX 17508
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32523
Mailing Address - Country:US
Mailing Address - Phone:850-995-4244
Mailing Address - Fax:850-995-9188
Practice Address - Street 1:3874 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571
Practice Address - Country:US
Practice Address - Phone:850-995-4244
Practice Address - Fax:850-995-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000727900Medicaid
AN593Medicare PIN