Abc Pediatrics of Okaloosa
Organization Active NPI Pediatric Adolescent Medicine Physician · Crestview, FL
NPI 1326418336 · NPPES record last updated Oct 2, 2015
Key facts
- NPI
- 1326418336
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatric Adolescent Medicine Physician 2080A0000X
- License
- ME70831 (FL)
- Legal business name
- ABC PEDIATRICS OF OKALOOSA
- Practice address
- 182 E. Redstone Ave
Suite B
Crestview, FL 32539 - Phone
- (850) 689-0900
- Fax
- (850) 689-0912
- NPI assigned
- Oct 2, 2015
- Organization subpart
- No
Authorized official
- Name
- Denise Mitchell
- Title
- Office Manager
- Phone
- (850) 689-0900
Corporate family (same tax ID) 2
National Provider Directory
- Tax ID family
- Abc Pediatrics
Locations
2260 S Ferdon Blvd
Crestview, FL 32536
Phone (850) 849-1642
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician |
2080A0000X | ME70831 | FL | Yes |
Addresses
Primary practice location
182 E. Redstone Ave
Suite B
Crestview, FL 32539
Mailing address
2260 S Ferdon Blvd
Box 92
Crestview, FL 32536-8457
Phone (850) 689-0900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 250009400 | Medicaid | FL |
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All providers in Crestview, FL · Pediatric Adolescent Medicine 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 Oct 2, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.