Provider Demographics
NPI:1841236726
Name:COMFORT CARE MEDICAL GROUP PA
Entity Type:Organization
Organization Name:COMFORT CARE MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CRUMLISH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:850-476-9088
Mailing Address - Street 1:4511 N DAVIS HWY
Mailing Address - Street 2:STE 1-C
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2720
Mailing Address - Country:US
Mailing Address - Phone:850-476-9088
Mailing Address - Fax:850-476-9902
Practice Address - Street 1:4511 N DAVIS HWY
Practice Address - Street 2:STE 1-C
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2720
Practice Address - Country:US
Practice Address - Phone:850-476-9088
Practice Address - Fax:850-476-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicare ID - Type Unspecified