1881674257 NPI number — FIRST PHYSICIANS GROUP PA

Table of content: (NPI 1881674257)

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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