Provider Demographics
NPI:1962489278
Name:PENSACOLA UROLOGY, PA
Entity Type:Organization
Organization Name:PENSACOLA UROLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE & BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:850-444-4707
Mailing Address - Street 1:1717 N E ST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6339
Mailing Address - Country:US
Mailing Address - Phone:850-444-4707
Mailing Address - Fax:850-432-2532
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:SUITE 430
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6339
Practice Address - Country:US
Practice Address - Phone:850-444-4707
Practice Address - Fax:850-432-2532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45772Medicare ID - Type Unspecified