Provider Demographics
NPI:1760479653
Name:EDITHA BIELITZ INC
Entity Type:Organization
Organization Name:EDITHA BIELITZ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIELITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-476-6060
Mailing Address - Street 1:4400 BAYOU BLVD
Mailing Address - Street 2:SUITE 52A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503
Mailing Address - Country:US
Mailing Address - Phone:850-476-6060
Mailing Address - Fax:850-476-6070
Practice Address - Street 1:4400 BAYOU BLVD
Practice Address - Street 2:STE. 52A
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503
Practice Address - Country:US
Practice Address - Phone:850-476-6060
Practice Address - Fax:850-476-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65517207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7851Medicare PIN