Healthcare Provider Details

I. General information

NPI: 1881674257
Provider Name (Legal Business Name): FIRST PHYSICIANS GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 10/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 HIGHWAY 90
PACE FL
32571-1014
US

IV. Provider business mailing address

PO BOX 18868
PENSACOLA FL
32523-8868
US

V. Phone/Fax

Practice location:
  • Phone: 850-994-5660
  • Fax: 850-994-5841
Mailing address:
  • Phone: 850-994-5660
  • Fax: 859-994-5841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: KYLIE BAISDEN
Title or Position: CREDENTIALING
Credential:
Phone: 850-994-5660