Provider Demographics
NPI:1235637497
Name:BEACH MIDWAY MED EXPRESS
Entity Type:Organization
Organization Name:BEACH MIDWAY MED EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ATA
Authorized Official - Middle Name:
Authorized Official - Last Name:ULHAQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-588-5778
Mailing Address - Street 1:8526 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3620
Mailing Address - Country:US
Mailing Address - Phone:330-758-2775
Mailing Address - Fax:330-758-2787
Practice Address - Street 1:11038 HUTCHISON BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32407
Practice Address - Country:US
Practice Address - Phone:850-588-5778
Practice Address - Fax:850-588-5718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty