Basic Information
| Provider Information | |||||||||
| NPI: | 1801213020 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHLAND HOSPITLALIST AT CHIPLEY, PL. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5218 | ||||||||
| Address2: | |||||||||
| City: | NICEVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325785218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508977244 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1360 BRICKYARD RD | ||||||||
| Address2: | |||||||||
| City: | CHIPLEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324286303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506381610 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2014 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | BELL | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8508977244 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.