Provider Demographics
NPI:1942765292
Name:ACCESS CARE FAMILY MEDICINE
Entity Type:Organization
Organization Name:ACCESS CARE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICD ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILABY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-912-6588
Mailing Address - Street 1:3344 WASATCH RANGE LOOP
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-2060
Mailing Address - Country:US
Mailing Address - Phone:850-512-5600
Mailing Address - Fax:850-912-6598
Practice Address - Street 1:6705 PINE FOREST RD STE 505
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-6911
Practice Address - Country:US
Practice Address - Phone:850-912-6588
Practice Address - Fax:850-912-6598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
009XMOtherBCBS