# FORT WALTON BEACH HEART & LUNG SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164443172
- **Authorized official:** KIM RILEY (BILLING COORDINATOR)
- **Authorized official phone:** (850) 651-9300

## Contact information

- **Practice address:** 1283 EGLIN PKWY, SUITE B, SHALIMAR, FL 32579-1256
- **Practice address phone:** (850) 651-9300
- **Practice address fax:** (850) 651-3345
- **Mailing address:** PO BOX 1150, SHALIMAR, FL 32579-5150
- **Mailing address phone:** (850) 651-9300
- **Mailing address fax:** (850) 651-3345

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | ME 87486 | FL | Yes |

## Other

- **Enumeration date:** 07/22/2006
- **Last updated:** 08/22/2020