Provider Demographics
NPI:1376532762
Name:PENSACOLA PRIMARY CARE, INC.
Entity Type:Organization
Organization Name:PENSACOLA PRIMARY CARE, INC.
Other - Org Name:DBA PENSACOLA PRIMARY CARE, INC.-W.FAIRFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRMINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7625
Mailing Address - Street 1:321 W FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1412
Mailing Address - Country:US
Mailing Address - Phone:850-474-8546
Mailing Address - Fax:850-479-9180
Practice Address - Street 1:321 W FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1412
Practice Address - Country:US
Practice Address - Phone:850-474-8546
Practice Address - Fax:850-479-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2580Medicare ID - Type Unspecified