Healthcare Provider Details

I. General information

NPI: 1265720957
Provider Name (Legal Business Name): ESCAMBIA COMMUNITY CLINIC INC-LANZA PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N PALAFOX ST
PENSACOLA FL
32501-1723
US

IV. Provider business mailing address

2200 N PALAFOX ST
PENSACOLA FL
32501-1723
US

V. Phone/Fax

Practice location:
  • Phone: 850-436-4630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number9340197
License Number StateFL

VIII. Authorized Official

Name: DON TURNER
Title or Position: CEO
Credential:
Phone: 850-436-4630