Provider Demographics
NPI:1750826178
Name:ACCIDENT ORTHOPEDICS
Entity Type:Organization
Organization Name:ACCIDENT ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SURGNIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-819-3268
Mailing Address - Street 1:3613 N HIGHWAY 231
Mailing Address - Street 2:SUITE B
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-9743
Mailing Address - Country:US
Mailing Address - Phone:850-819-3268
Mailing Address - Fax:850-215-1708
Practice Address - Street 1:3613 N HIGHWAY 231
Practice Address - Street 2:SUITE B
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-9743
Practice Address - Country:US
Practice Address - Phone:850-819-3268
Practice Address - Fax:850-215-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35645261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD21522Medicare UPIN