Provider Demographics
NPI:1508054594
Name:ACCESS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ACCESS MEDICAL GROUP, INC.
Other - Org Name:ACCESS MEDICAL GROUP PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-226-2895
Mailing Address - Street 1:4554 E HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-9755
Mailing Address - Country:US
Mailing Address - Phone:850-897-1824
Mailing Address - Fax:850-897-1827
Practice Address - Street 1:4554 E HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-9755
Practice Address - Country:US
Practice Address - Phone:850-897-1824
Practice Address - Fax:850-897-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0029230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72451Medicare PIN
FLE23009Medicare UPIN