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Contact Information

CRESTVIEW PEDIATRICS AND ADOLESCENT CENTER PA
332 MEDCREST DRIVE
CRESTVIEW, FL32536
 Phone: 850-683-5100
 Fax: 850-683-5102
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for CRESTVIEW PEDIATRICS AND ADOLESCENT CENTER PA

NPI Number 1891850855
LBN Legal business name CRESTVIEW PEDIATRICS AND ADOLESCENT CENTER PA
Authorized official BERNADINE PETER - (OFFICE MGR)
Entity Organization
Organization subpart 1 No
Enumeration date 12/27/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
FL License # ME74916
FL Other 94749 BCBS
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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