Provider Demographics
NPI:1356762660
Name:PENSACOLA MEDICAL CLINIC, LLC
Entity type:Organization
Organization Name:PENSACOLA MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:LAM
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-867-1551
Mailing Address - Street 1:306 GARFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-3614
Mailing Address - Country:US
Mailing Address - Phone:518-867-1551
Mailing Address - Fax:
Practice Address - Street 1:2407 W CERVANTES ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-7150
Practice Address - Country:US
Practice Address - Phone:518-867-1551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-04
Last Update Date:2014-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN488261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care