| Child Neurology Center Of Northwest Florida Pa | |
|
400 Gulf Breeze Pkwy Suite 300 Gulf Breeze FL 32561-4495 | |
| (850) 932-5055 | |
| (850) 932-1401 |
| Full Name | Child Neurology Center Of Northwest Florida Pa |
|---|---|
| Speciality | General Practice |
| Location | 400 Gulf Breeze Pkwy, Gulf Breeze, Florida |
| Authorized Official Name and Position | James Ben Renfroe (OWNER) |
| Authorized Official Contact | 8509325055 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Child Neurology Center Of Northwest Florida Pa Po Box 280 Gulf Breeze FL 32562-0280 Ph: (850) 932-5055 | Child Neurology Center Of Northwest Florida Pa 400 Gulf Breeze Pkwy Suite 300 Gulf Breeze FL 32561-4495 Ph: (850) 932-5055 |
| NPI Number | 1053392233 |
|---|---|
| Provider Enumeration Date | 11/07/2005 |
| Last Update Date | 01/20/2025 |
| Certification Date | 01/20/2025 |
| Medicare PECOS PAC ID | 3870584345 |
|---|---|
| Medicare Enrollment ID | O20040522000075 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053392233 | NPI | - | NPPES |
| 529918930 | Medicaid | AL | |
| 257889100 | Medicaid | FL |
| Provider Name | James Benjamin Renfroe |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1780686717 PECOS PAC ID: 4880683960 Enrollment ID: I20040628000169 |
| Provider Name | Weldon Mauney |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1396915898 PECOS PAC ID: 5890835433 Enrollment ID: I20091212000120 |
| Provider Name | Deron Sharpe |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1104913235 PECOS PAC ID: 3678477254 Enrollment ID: I20221025001382 |
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