Provider Demographics
NPI:1609992288
Name:PHAMHASELL PA
Entity Type:Organization
Organization Name:PHAMHASELL PA
Other - Org Name:THE PEDIATRIC SPECIALISTS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLASS
Authorized Official - Middle Name:MORRISON
Authorized Official - Last Name:HASELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-375-5437
Mailing Address - Street 1:2044 TRINITY OAKS BLVD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4405
Mailing Address - Country:US
Mailing Address - Phone:727-375-5437
Mailing Address - Fax:727-375-0502
Practice Address - Street 1:2044 TRINITY OAKS BLVD
Practice Address - Street 2:SUITE 235
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4405
Practice Address - Country:US
Practice Address - Phone:727-375-5437
Practice Address - Fax:727-375-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275731100Medicaid