| Southern Orthopedic Specialists P A | |
|
1827 Harrison Ave Panama City FL 32405-7605 | |
| (850) 785-4344 | |
| (850) 785-6568 |
| Full Name | Southern Orthopedic Specialists P A |
|---|---|
| Speciality | Orthopaedic Surgery |
| Location | 1827 Harrison Ave, Panama City, Florida |
| Authorized Official Name and Position | Rebecca Carreira (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 8507634364 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Orthopedic Specialists P A 1827 Harrison Ave Panama City FL 32405-7605 Ph: (850) 785-4344 | Southern Orthopedic Specialists P A 1827 Harrison Ave Panama City FL 32405-7605 Ph: (850) 785-4344 |
| NPI Number | 1407892938 |
|---|---|
| Provider Enumeration Date | 06/22/2006 |
| Last Update Date | 03/22/2012 |
| Medicare PECOS PAC ID | 4082511001 |
|---|---|
| Medicare Enrollment ID | O20040105000558 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407892938 | NPI | - | NPPES |
| 45261 | Other | FL | GROUP BCBS NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Secondary |
| 207X00000X | Orthopaedic Surgery | (* (Not Available)) | Primary |
| Provider Name | Brenda S Clements |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1720077670 PECOS PAC ID: 0941284137 Enrollment ID: I20040615001596 |
| Provider Name | Nicole T Schenkel |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1386669737 PECOS PAC ID: 7012012958 Enrollment ID: I20070420000375 |
| Provider Name | Michael Noble |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598794976 PECOS PAC ID: 5890827471 Enrollment ID: I20100716000597 |
| Provider Name | Thomas Mitchell |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1780613166 PECOS PAC ID: 3274431820 Enrollment ID: I20100716000713 |
| Provider Name | John R Cotton |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1104987114 PECOS PAC ID: 5496891087 Enrollment ID: I20100929001617 |
| Provider Name | Gina M Nolan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811293392 PECOS PAC ID: 3476738345 Enrollment ID: I20110420000157 |
| Provider Name | Michelle M Kavouras |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1760449086 PECOS PAC ID: 8325210057 Enrollment ID: I20110930000450 |
| Provider Name | Mark N Awantang |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1285851907 PECOS PAC ID: 8426124496 Enrollment ID: I20120417000121 |
| Provider Name | Catherine M Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619370616 PECOS PAC ID: 6709109325 Enrollment ID: I20150106000806 |
| Provider Name | Nicholas W Crossman |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1346528437 PECOS PAC ID: 6002124211 Enrollment ID: I20181116001323 |
| Provider Name | Kelsey Diane Barr |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1407313075 PECOS PAC ID: 3274873906 Enrollment ID: I20190315002540 |
| Provider Name | Ryan M Perry |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1992145353 PECOS PAC ID: 4981906849 Enrollment ID: I20200828001302 |
| Provider Name | Marta Mauney Salter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336751585 PECOS PAC ID: 2961822721 Enrollment ID: I20201015002386 |
| Provider Name | Robyn Varner |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1184847824 PECOS PAC ID: 1052749413 Enrollment ID: I20201103001370 |
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