Provider Demographics
NPI:1578897476
Name:THE GALEN GROUP
Entity Type:Organization
Organization Name:THE GALEN GROUP
Other - Org Name:EXPRESSCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:K
Authorized Official - Last Name:SAFARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-797-2123
Mailing Address - Street 1:536 SEA WINDS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-4395
Mailing Address - Country:US
Mailing Address - Phone:850-797-2123
Mailing Address - Fax:850-391-5100
Practice Address - Street 1:536 SEA WINDS DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-4395
Practice Address - Country:US
Practice Address - Phone:850-797-2123
Practice Address - Fax:850-391-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL85762207P00000X, 207Q00000X, 207QA0401X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL536SWDMedicaid
FL536SWDMedicare UPIN
FL536SWDMedicare Oscar/Certification
FL536SWDMedicare PIN