Provider Demographics
NPI:1245547470
Name:BAPTIST MEDICAL GROUP - OBGYN LLC
Entity type:Organization
Organization Name:BAPTIST MEDICAL GROUP - OBGYN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOLROOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-469-2334
Mailing Address - Street 1:1717 N E ST
Mailing Address - Street 2:SUITE 334
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6339
Mailing Address - Country:US
Mailing Address - Phone:850-437-8604
Mailing Address - Fax:
Practice Address - Street 1:3417 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-4008
Practice Address - Country:US
Practice Address - Phone:850-437-8604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPSTIST HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-09
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty