Provider Demographics
NPI:1326027319
Name:CHARLES B BARNIV MD PA
Entity Type:Organization
Organization Name:CHARLES B BARNIV MD PA
Other - Org Name:DESTIN MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:BARNIV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-837-5181
Mailing Address - Street 1:PO BOX 1719
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32540-1719
Mailing Address - Country:US
Mailing Address - Phone:850-837-5181
Mailing Address - Fax:850-837-6623
Practice Address - Street 1:623 HARBOR BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2466
Practice Address - Country:US
Practice Address - Phone:850-837-5181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46152OtherBCBS
FL02270X30048OtherRR MEDICARE
D54968Medicare UPIN
FLK4702Medicare PIN