The Pathology Group of Northwest Florida PLLC
Organization Active NPI Anatomic Pathology & Clinical Pathology Physician · Pensacola, FL
NPI 1114153269 · NPPES record last updated Apr 11, 2023
Key facts
- NPI
- 1114153269
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
- Legal business name
- THE PATHOLOGY GROUP OF NORTHWEST FLORIDA PLLC
- Practice address
- 4724 N Davis Hwy FL 2
Pensacola, FL 32503-2339 - Phone
- (850) 438-1154
- NPI assigned
- Jun 3, 2009
- Organization subpart
- No
Authorized official
- Name
- North J Davis, MD
- Title
- President
- Phone
- (850) 438-1154
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 2
Practitioners 57
-
North Joseph Davis, M.D.
-
Janis P McNeil, MD
-
Muhammad Amin, M.D.
-
Leisa H Bailey, M.D.
-
Jimmy Rafael Carrillo, PA-C
-
Kongsak Chantornsaeng, M.D.
-
Kyle Vincent Contini, M.D.
-
Timothy Dale Fowler Jr., P.A.
-
Dawn Rene Frost, 363L00000X
-
Louis Gombkoto, PAC
-
Patrick L Hawkins, M.D.
-
Michael A Jaindl, MD
-
Sarah Mikel James, ARNP
-
Timra Shea Jerkins, APRN
-
Michael W Jeter, APRN, FNP-C
-
Karen Gail Smith Johnson, ARNP
-
Michael Dee Kennedy, ARNP
-
Jessica Register Ludwig, ARNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091002000593 | FL | Part B Supplier - Clinic/Group Practice | 8123164233 |
Receives reassigned benefits from 2 practitioners 1 other NPI on this enrollment Practice locations: Bonifay, FL; Crestview, FL; Defuniak Springs, FL; Pensacola, FL |
| O20091002000652 | FL | Part B Supplier - Independent Clinical Laboratory | 8123164233 | Practice locations: Pensacola, FL |
National Provider Directory
- Tax ID family
- The Pathology Group of Northwest Florida PLLC
Locations
4413 US Highway 331 S
Defuniak Springs, FL 32435
Phone (850) 892-5171
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician |
207ZP0102X | Yes |
Addresses
Primary practice location
4724 N Davis Hwy FL 2
Pensacola, FL 32503-2339
Mailing address
PO Box 3093
Boca Raton, FL 33431-0993
Phone (850) 438-1154
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00047 | Other | FL | BCBS OF FL |
| 001366802 | Medicaid | FL | |
| 00047A | Other | FL | BCBS OF FL |
| 001366801 | Medicaid | FL | |
| 00047C | Other | FL | BCBS OF FL |
| 001366800 | Medicaid | FL |
Other providers in Pensacola, FL
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- The Neurosurgical Group Sisco & Tippett Chapleau & Frank
- The Pantry Raider
- The Rhema House Assisted Living Facility,Inc
- The School District of Escambia County
- The Smile Mission Pensacola PLLC
- The Southern Practitioner Group
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All providers in Pensacola, FL · Anatomic Pathology & Clinical Pathology Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 11, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.