Provider Demographics
NPI:1497020549
Name:ESCAMBIA COMMUNITY CLINICS INC
Entity Type:Organization
Organization Name:ESCAMBIA COMMUNITY CLINICS INC
Other - Org Name:PALAFOX PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-436-4630
Mailing Address - Street 1:2315 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-7552
Mailing Address - Country:US
Mailing Address - Phone:850-436-4630
Mailing Address - Fax:850-436-2095
Practice Address - Street 1:1400 N PALAFOX ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-2643
Practice Address - Country:US
Practice Address - Phone:850-444-9449
Practice Address - Fax:850-390-4933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESCAMBIA COMMUNITY CLINICS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-21
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692990728Medicaid