Basic Information
| Provider Information | |||||||||
| NPI: | 1366773566 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NW FLORIDA EMERGENCY PHYSICIANS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 534600 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303534600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005141494 | ||||||||
| FaxNumber: | 9048051312 | ||||||||
| Practice Location | |||||||||
| Address1: | 6002 BERRYHILL RD | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325705062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506267762 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2010 | ||||||||
| LastUpdateDate: | 05/10/2010 | ||||||||
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| AuthorizedOfficialLastName: | CRASS | ||||||||
| AuthorizedOfficialFirstName: | SARAH | ||||||||
| AuthorizedOfficialMiddleName: | C.H. | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9048051300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000LT | 01 | FL | BCBS | OTHER | DQ0330 | 01 | FL | RAILROAD MEDICARE | OTHER | 116975 | 05 | AL | MEDICAID |