Provider Demographics
NPI:1194371963
Name:ANCHOR MULTISPECIALTY GROUP
Entity Type:Organization
Organization Name:ANCHOR MULTISPECIALTY GROUP
Other - Org Name:ANCHOR MULTISPECIALTY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:GROOM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-433-6760
Mailing Address - Street 1:890 S PALAFOX ST UNIT 300
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-5905
Mailing Address - Country:US
Mailing Address - Phone:850-433-1656
Mailing Address - Fax:850-433-1696
Practice Address - Street 1:850 S PALAFOX ST UNIT 103
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5983
Practice Address - Country:US
Practice Address - Phone:850-433-6760
Practice Address - Fax:850-433-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty