Provider Demographics
NPI:1558386326
Name:PENSACOLA SURGICAL GROUP PA
Entity Type:Organization
Organization Name:PENSACOLA SURGICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-444-4741
Mailing Address - Street 1:1717 N E ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6339
Mailing Address - Country:US
Mailing Address - Phone:850-444-4741
Mailing Address - Fax:850-438-7169
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6339
Practice Address - Country:US
Practice Address - Phone:850-444-4741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21370Medicare PIN