1952825259 NPI number — SUSAN CULVERHOUSE, MD PA

Table of content: (NPI 1952825259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952825259 NPI number — SUSAN CULVERHOUSE, MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN CULVERHOUSE, MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952825259
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
707 E CERVANTES ST, SUITE B #298
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-272-4232
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 E 6TH ST STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PANAMA CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32401-3667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-763-8680
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2017

Additional Information

Authorized Official

Authorized Official Last Name:
CULVERHOUSE
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
HOWARD
Authorized Official Title or Position:
MD / PRESIDENT
Authorized Official Telephone Number:
813-784-3746

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  ME106708 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009329900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com