1376532762 NPI number — PENSACOLA PRIMARY CARE, INC.

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 1376532762 NPI number — PENSACOLA PRIMARY CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENSACOLA PRIMARY CARE, INC.
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:
DBA PENSACOLA PRIMARY CARE, INC.-W.FAIRFIELD
Provider Other Organization Name Type Code:
3
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:
1376532762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 W FAIRFIELD DR
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:
32501-1412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-474-8546
Provider Business Mailing Address Fax Number:
850-479-9180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 W FAIRFIELD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32501-1412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-474-8546
Provider Business Practice Location Address Fax Number:
850-479-9180
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BIRMINGHAM
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
615-373-7625

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com