Provider Demographics
NPI:1770902462
Name:PRIMARY CARE HOUSE CALLS PA
Entity type:Organization
Organization Name:PRIMARY CARE HOUSE CALLS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMLISH
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:850-516-8737
Mailing Address - Street 1:2744 GULF BREEZE PKWY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3091
Mailing Address - Country:US
Mailing Address - Phone:850-934-5713
Mailing Address - Fax:850-934-0379
Practice Address - Street 1:2744 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3091
Practice Address - Country:US
Practice Address - Phone:850-934-5713
Practice Address - Fax:850-934-0379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1866262363LF0000X
FLARNP9102271363LG0600X
FLPA9102271363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty