Provider Demographics
NPI:1164434031
Name:BERRYHILL ORTHOPAEDICS, PA
Entity Type:Organization
Organization Name:BERRYHILL ORTHOPAEDICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANEL
Authorized Official - Middle Name:DAWNETTE
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-626-1461
Mailing Address - Street 1:6007 BERRYHILL RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-4008
Mailing Address - Country:US
Mailing Address - Phone:850-626-1461
Mailing Address - Fax:850-626-3161
Practice Address - Street 1:6007 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4008
Practice Address - Country:US
Practice Address - Phone:850-626-1461
Practice Address - Fax:850-626-3161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044109174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57095OtherBCBS FLORIDA
FL068633600Medicaid
AK529502660Medicaid
AK529502660Medicaid
FLD56810Medicare UPIN
FL57095XMedicare PIN