1417348830 NPI number — COYLE INSTITUTE FOR FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY

Table of content: (NPI 1417348830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417348830 NPI number — COYLE INSTITUTE FOR FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COYLE INSTITUTE FOR FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY
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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1417348830
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9295 SCENIC HWY
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:
32514-8055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-983-3528
Provider Business Mailing Address Fax Number:
850-983-3546

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9295 SCENIC HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32514-8055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-983-3528
Provider Business Practice Location Address Fax Number:
850-983-3546
Provider Enumeration Date:
02/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
KRISTI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
850-983-3528

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  OS9063 , 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: 269991500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00A6D . This is a "BCBSFL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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