MEDICARE: PENSACOLA PRIMARY CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS 5154	FL

General Provider Information

NPI Number	:	1467434860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENSACOLA PRIMARY CARE INC

Provider Business Mailing Address
First Line	:	6431 NORTH 'W' STREET
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504
Country	:	US
Telephone Number	:	850-474-3660
Fax Number	:	850-474-3659

Provider Business Practice Location Address
First Line	:	6431 NORTH 'W' STREET
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32505
Country	:	US
Telephone Number	:	850-474-3660
Fax Number	:	850-474-3659

Authorized Official
Title or Position	:	D.O.
Name	:	DR. MICHAEL E KASABIAN
Credential	:	D.O.
Telephone Number	:	850-474-3660

Provider Enumeration Date	:	11/19/2005
Last Update Date	:	11/07/2007

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