1881674257 NPI number — FIRST PHYSICIANS GROUP PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881674257 NPI number — FIRST PHYSICIANS GROUP PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST PHYSICIANS GROUP PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881674257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 18868
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32523-8868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-994-5660
Provider Business Mailing Address Fax Number:
859-994-5841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3802 HIGHWAY 90
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PACE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32571-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-994-5660
Provider Business Practice Location Address Fax Number:
850-994-5841
Provider Enumeration Date:
01/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAISDEN
Authorized Official First Name:
KYLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
850-994-5660

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 261372508 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 261372505 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 261372506 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 263172510 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 608177300 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CA7660 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0582 . This is a "HEALTHY KIDS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 263172501 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38502 . This is a "BLUE CROSS BLUE SHIELD FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 261372500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 261372502 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 261372509 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 263172503 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0582 . This is a "HEALTH OPTIONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 261372507 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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