Provider Demographics
NPI:1215948096
Name:PANHANDLE EMERGENCY PHYSICIANS A DIV OF SACRED HEART HOSP PENSACOLA
Entity type:Organization
Organization Name:PANHANDLE EMERGENCY PHYSICIANS A DIV OF SACRED HEART HOSP PENSACOLA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR; HEALTHPLAN ENROLLMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-475-4682
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-475-4500
Mailing Address - Fax:850-475-4781
Practice Address - Street 1:5151 N 9TH AVE
Practice Address - Street 2:ER
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8721
Practice Address - Country:US
Practice Address - Phone:850-416-7000
Practice Address - Fax:850-416-4694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5839Medicare PIN