Provider Demographics
NPI:1568603702
Name:FIRST CLASS MD, PA
Entity Type:Organization
Organization Name:FIRST CLASS MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-939-4150
Mailing Address - Street 1:7552 NAVARRE PARKWAY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566
Mailing Address - Country:US
Mailing Address - Phone:850-939-4150
Mailing Address - Fax:850-936-5277
Practice Address - Street 1:7552 NAVARRE PARKWAY
Practice Address - Street 2:SUITE 5
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566
Practice Address - Country:US
Practice Address - Phone:850-939-4150
Practice Address - Fax:850-936-5277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care