Provider Demographics
NPI:1942344106
Name:SOUTHEAST ASSOCIATION OF HEALTHCARE PROVIDERS INC
Entity Type:Organization
Organization Name:SOUTHEAST ASSOCIATION OF HEALTHCARE PROVIDERS INC
Other - Org Name:RETURN TO HEALTH MEDICAL HOME AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:E
Authorized Official - Last Name:RENFROE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-477-8874
Mailing Address - Street 1:5330 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2006
Mailing Address - Country:US
Mailing Address - Phone:850-477-8874
Mailing Address - Fax:850-477-8865
Practice Address - Street 1:5330 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2006
Practice Address - Country:US
Practice Address - Phone:850-477-8874
Practice Address - Fax:850-477-8865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6343111N00000X
FLCH6348111N00000X
FLCH8124111N00000X
FLME92143208D00000X
FLPT4977225100000X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99322OtherBCBS GROUP NO.
FL99322OtherBCBS GROUP NO.