Provider Demographics
NPI:1023499662
Name:SUPERIOR HEALTHCARE AND PHYSICAL MEDICINE OF NAVARRE INC
Entity type:Organization
Organization Name:SUPERIOR HEALTHCARE AND PHYSICAL MEDICINE OF NAVARRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-936-8664
Mailing Address - Street 1:2542 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-8257
Mailing Address - Country:US
Mailing Address - Phone:850-936-8664
Mailing Address - Fax:850-936-4229
Practice Address - Street 1:1796 NAVARRE SOUND CIRCLE
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566
Practice Address - Country:US
Practice Address - Phone:850-936-8664
Practice Address - Fax:850-936-4229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7459111N00000X
FLME73433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIG377AMedicare PIN