Provider Demographics
NPI:1871815340
Name:GADSDEN FAMILY CLINIC, PA
Entity Type:Organization
Organization Name:GADSDEN FAMILY CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:CAMACHO
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-875-2125
Mailing Address - Street 1:304 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-2530
Mailing Address - Country:US
Mailing Address - Phone:850-875-2125
Mailing Address - Fax:850-875-4689
Practice Address - Street 1:304 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-2530
Practice Address - Country:US
Practice Address - Phone:850-875-2125
Practice Address - Fax:850-875-4689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0029888261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036738900Medicaid
FL036738900Medicaid
FL20044Medicare PIN