Provider Demographics
NPI:1073528477
Name:THE NEUROSURGICAL GROUP SISCO & TIPPETT CHAPLEAU & FRANK
Entity Type:Organization
Organization Name:THE NEUROSURGICAL GROUP SISCO & TIPPETT CHAPLEAU & FRANK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHAPLEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-444-7050
Mailing Address - Street 1:1717 N E ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6378
Mailing Address - Country:US
Mailing Address - Phone:850-444-7050
Mailing Address - Fax:850-434-8879
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:SUITE 422
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6339
Practice Address - Country:US
Practice Address - Phone:850-444-7050
Practice Address - Fax:850-434-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036686200Medicaid
FL036686200Medicaid