Provider Demographics
NPI:1235775396
Name:PHYSICIAN SERVICES GROUP OF FLORIDA, LLC
Entity Type:Organization
Organization Name:PHYSICIAN SERVICES GROUP OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-303-8650
Mailing Address - Street 1:8325 UNIVERSITY PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-4949
Mailing Address - Country:US
Mailing Address - Phone:850-324-9633
Mailing Address - Fax:850-470-6460
Practice Address - Street 1:8325 UNIVERSITY PKWY STE A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-4949
Practice Address - Country:US
Practice Address - Phone:850-324-9633
Practice Address - Fax:850-470-6460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty