Provider Demographics
NPI:1629161435
Name:THE ANCHOR CLINIC, LLC
Entity Type:Organization
Organization Name:THE ANCHOR CLINIC, LLC
Other - Org Name:ANCHOR CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:GROOM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-433-6760
Mailing Address - Street 1:890 SOUTH PALAFOX STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502
Mailing Address - Country:US
Mailing Address - Phone:850-433-1656
Mailing Address - Fax:850-433-1996
Practice Address - Street 1:890 SOUTH PALAFOX STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502
Practice Address - Country:US
Practice Address - Phone:850-433-1656
Practice Address - Fax:850-433-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty