Healthcare Provider Details

I. General information

NPI: 1629789466
Provider Name (Legal Business Name): ESCAMBIA COMMUNITY CLINICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 LONGLEAF DR BLDG A
PENSACOLA FL
32526-8930
US

IV. Provider business mailing address

2315 W JACKSON ST
PENSACOLA FL
32505-7552
US

V. Phone/Fax

Practice location:
  • Phone: 850-665-3252
  • Fax: 850-512-1554
Mailing address:
  • Phone: 850-436-4630
  • Fax: 850-436-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHANDRA SMILEY
Title or Position: CEO
Credential:
Phone: 850-436-4630