Organization
ER PHYSICIAN GROUP AT JACKSON HOSPITAL
Active
Other names
Womens Healthcare of The Panhandle
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BELINDA HIDLE (COMPLIANCE OFFICER)
(850) 718-2644
Entity
Organization
Contact information
Practice address
4298 5TH AVE, MARIANNA, FL 32446-2173
(850) 482-5787
(850) 482-8108
Mailing address
4298 5TH AVE, MARIANNA, FL 32446-2173
(850) 482-5787
(850) 482-8108
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME78684 AND ME93313
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0142
MEDICARE FIRST COAST
FL
05
—
054877400
—
FL
05
—
270213400
—
FL
05
—
272901600
—
FL
01
—
38679
BLUE CROSS
FL
Enumeration date
06/05/2006
Last updated
07/03/2008
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