Provider Demographics
NPI:1811354129
Name:THE DIABETES AND ENDOCRINE CENTER OF PENSACOLA LLC
Entity type:Organization
Organization Name:THE DIABETES AND ENDOCRINE CENTER OF PENSACOLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:VISHNU
Authorized Official - Middle Name:NARAYAN
Authorized Official - Last Name:BEHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-208-3848
Mailing Address - Street 1:6160 N DAVIS HWY
Mailing Address - Street 2:SUITE 10A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6994
Mailing Address - Country:US
Mailing Address - Phone:850-208-3848
Mailing Address - Fax:850-476-0602
Practice Address - Street 1:6160 N DAVIS HWY
Practice Address - Street 2:SUITE 10A
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6994
Practice Address - Country:US
Practice Address - Phone:850-208-3848
Practice Address - Fax:850-208-3848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL98582261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279086600Medicaid
FLF78776Medicare UPIN
FL279086600Medicaid