Organization
FORT WALTON BEACH HEART & LUNG SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM RILEY (BILLING COORDINATOR)
(850) 651-9300
Entity
Organization
Contact information
Practice address
1283 EGLIN PKWY, SUITE B, SHALIMAR, FL 32579-1256
(850) 651-9300
(850) 651-3345
Mailing address
PO BOX 1150, SHALIMAR, FL 32579-5150
(850) 651-9300
(850) 651-3345
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
ME 87486
FL
Other
Enumeration date
07/22/2006
Last updated
08/22/2020
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