NPIMap

Organization Active NPI

4MD2 Physician Services of Niceville LLC

  • Emergency Medicine Physician
  • Niceville, FL
National Provider Identifier
1902857972
Registry record updated Jul 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
4MD2 PHYSICIAN SERVICES OF NICEVILLE LLC
Practice address
2190 Highway 85 N
Niceville, FL 32578-1045
Phone
(850) 729-9490
Fax
(205) 437-5998
NPI assigned
May 15, 2006
Last updated
Jul 20, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Guy Duwane Hooper
Title
President
Phone
(205) 437-6098

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

2190 Highway 85 N
Niceville, FL 32578-1045

Mailing address

PO Box 88490
Chicago, IL 60680-1490
Phone (205) 437-6098

Other identifiers 5

IdentifierTypeStateIssuer
7946836OtherFLAETNA GROUP NO
97861OtherFLGROUP BCBS NUMBER
DE3244OtherFLGROUP RRMC NUMBER
F952OtherALBCBS GROUP NO
2621276OtherFLUNITEDHEALTHCARE OF FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184889600000",
    "number": "1902857972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88490",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606801490",
            "telephone_number": "205-437-6098",
            "fax_number": "205-437-5998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2190 HIGHWAY 85 N",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325781045",
            "telephone_number": "850-729-9490",
            "fax_number": "205-437-5998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "4MD2 PHYSICIAN SERVICES OF NICEVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-15",
        "last_updated": "2007-07-20",
        "status": "A",
        "authorized_official_last_name": "HOOPER",
        "authorized_official_first_name": "GUY",
        "authorized_official_middle_name": "DUWANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "205-437-6098"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA GROUP NO",
            "identifier": "7946836",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP BCBS NUMBER",
            "identifier": "97861",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP RRMC NUMBER",
            "identifier": "DE3244",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NO",
            "identifier": "F952",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITEDHEALTHCARE OF FL",
            "identifier": "2621276",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Niceville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.