Provider Demographics
NPI:1588646244
Name:PENSACOLA ORTHOPAEDICS & SPORTS MEDICINE, PA
Entity Type:Organization
Organization Name:PENSACOLA ORTHOPAEDICS & SPORTS MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TURBERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-474-9995
Mailing Address - Street 1:5147 N 9TH AVE
Mailing Address - Street 2:SUITE 322
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8710
Mailing Address - Country:US
Mailing Address - Phone:850-474-9995
Mailing Address - Fax:850-477-6021
Practice Address - Street 1:5147 N 9TH AVE
Practice Address - Street 2:SUITE 322
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8710
Practice Address - Country:US
Practice Address - Phone:850-474-9995
Practice Address - Fax:850-477-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265146700Medicaid
AL529914580Medicaid
FL265146700Medicaid
FL4620190001Medicare NSC