Provider Demographics
NPI:1841569357
Name:CHILD NEUROLOGY CENTER OF NW FL PA
Entity Type:Organization
Organization Name:CHILD NEUROLOGY CENTER OF NW FL PA
Other - Org Name:CNC SLEEP
Other - Org Type:Other Name
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SUHRBIER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:850-932-5055
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32562-0280
Mailing Address - Country:US
Mailing Address - Phone:850-932-5055
Mailing Address - Fax:850-916-9331
Practice Address - Street 1:400 GULF BREEZE PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4495
Practice Address - Country:US
Practice Address - Phone:850-932-5055
Practice Address - Fax:850-432-1401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILD NEUROLOGY CENTER OF NW FL PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45632Medicare PIN