| Ochsner 65 Plus Pensacola - University, L.l.c. | |
|
1095 E Nine Mile Rd Unit 1 Pensacola FL 32514-7485 | |
| (850) 558-4665 | |
| Not Available |
| Full Name | Ochsner 65 Plus Pensacola - University, L.l.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1095 E Nine Mile Rd Unit 1, Pensacola, Florida |
| Authorized Official Name and Position | Thomas Duncan (CEO) |
| Authorized Official Contact | 8505584665 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ochsner 65 Plus Pensacola - University, L.l.c. 1514 Jefferson Hwy New Orleans LA 70121-2429 Ph: () - | Ochsner 65 Plus Pensacola - University, L.l.c. 1095 E Nine Mile Rd Unit 1 Pensacola FL 32514-7485 Ph: (850) 558-4665 |
| NPI Number | 1962111005 |
|---|---|
| Provider Enumeration Date | 11/17/2022 |
| Last Update Date | 11/17/2022 |
| Medicare PECOS PAC ID | 8224402052 |
|---|---|
| Medicare Enrollment ID | O20230317002610 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962111005 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Terry L Payne |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053396002 PECOS PAC ID: 0446391429 Enrollment ID: I20100113000384 |
| Provider Name | Rebecca Broschart |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205824869 PECOS PAC ID: 6507857661 Enrollment ID: I20230320003024 |
| Provider Name | Kenneth L Bull |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356602114 PECOS PAC ID: 7012312747 Enrollment ID: I20240129000968 |
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