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General NPI Number Information
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NPI Number | 1063798478
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Entity Type | Organization
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Legal Business Name | PHOENIX FAMILY HEALTH CARE CENTER
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Dates
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Enumeration Date | 10/30/2011
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 1581 HIGHWAY 98 W
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City | CARRABELLE
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State | FL
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Zip | 32322-5009
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Country | US
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Telephone | 850-697-3420
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Fax | 850-697-3423
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Provider Business Mailing Address
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Address Line | 1581 HIGHWAY 98 W
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City | CARRABELLE
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State | FL
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Zip | 32322-5009
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Country | US
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Telephone | 850-697-3420
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Fax | 850-697-3423
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Authorized Official
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Title or Position | VP BUSINESS MANAGER
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Name | DR. LOIS MARIE MENDEZ CATLIN
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Credential | ED.D.
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Telephone | 850-697-3420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ACN212
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License Number State | FL
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