| None | |
|
155 Crystal Beach Dr Ste 200 Destin FL 32541-3588 | |
| (850) 353-2055 | |
| (855) 344-6080 |
| Full Name | None |
|---|---|
| Speciality | Neurological Surgery |
| Location | 155 Crystal Beach Dr Ste 200, Destin, Florida |
| Authorized Official Name and Position | Timothy R Monroe (PRESIDENT; OWNER) |
| Authorized Official Contact | 8503532055 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| None 155 Crystal Beach Dr Ste 200 Destin FL 32541-3588 Ph: (850) 353-2055 | None 155 Crystal Beach Dr Ste 200 Destin FL 32541-3588 Ph: (850) 353-2055 |
| NPI Number | 1396458329 |
|---|---|
| Provider Enumeration Date | 01/04/2023 |
| Last Update Date | 07/21/2023 |
| Medicare PECOS PAC ID | 0042683559 |
|---|---|
| Medicare Enrollment ID | O20230303001243 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396458329 | NPI | - | NPPES |
| Provider Name | David Preston Johnson |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1134530926 PECOS PAC ID: 9638396963 Enrollment ID: I20190710001765 |
| Provider Name | Timothy R Monroe |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1952487241 PECOS PAC ID: 5698944908 Enrollment ID: I20200813001323 |
| Provider Name | Kelsey Youell Hilley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457954810 PECOS PAC ID: 3870901200 Enrollment ID: I20230920003881 |
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