Healthcare Provider Details

I. General information

NPI: 1508286543
Provider Name (Legal Business Name): ACSH PRIMARY CARE OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 HIGHWAY 77
PANAMA CITY FL
32405-4404
US

IV. Provider business mailing address

PO BOX 101024
ATLANTA GA
30392-1024
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-9744
  • Fax: 850-785-2020
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NORMAN WINLAND
Title or Position: COO
Credential:
Phone: 404-465-1000