Provider Demographics
NPI:1417077090
Name:BAPTIST MEDICAL PARK SURGERY CENTER LLC
Entity Type:Organization
Organization Name:BAPTIST MEDICAL PARK SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. MANAGER OF ASC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:CHAMPAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:448-227-4172
Mailing Address - Street 1:9400 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5752
Mailing Address - Country:US
Mailing Address - Phone:448-227-4172
Mailing Address - Fax:850-208-6335
Practice Address - Street 1:9400 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5752
Practice Address - Country:US
Practice Address - Phone:448-227-4172
Practice Address - Fax:850-208-6335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0706205Medicaid
F1327Medicare ID - Type Unspecified