Provider Demographics
NPI:1649543182
Name:BAPTIST MEDICAL GROUP LLC
Entity type:Organization
Organization Name:BAPTIST MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOLROOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-434-4011
Mailing Address - Street 1:245 W AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-2254
Mailing Address - Country:US
Mailing Address - Phone:850-475-3726
Mailing Address - Fax:850-505-0079
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:SUITE 208
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6339
Practice Address - Country:US
Practice Address - Phone:850-469-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty