Provider Demographics
NPI:1760439319
Name:WEST FLORIDA REGIONAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:WEST FLORIDA REGIONAL MEDICAL CENTER INC
Other - Org Name:WEST FLORIDA HOSPITAL PHYSICIAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-494-4125
Mailing Address - Street 1:PO BOX 17300
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32522-7300
Mailing Address - Country:US
Mailing Address - Phone:850-494-5403
Mailing Address - Fax:850-494-4910
Practice Address - Street 1:8383 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6039
Practice Address - Country:US
Practice Address - Phone:850-494-5403
Practice Address - Fax:850-494-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00830Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER