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General NPI Number Information
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NPI Number | 1356762660
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Entity Type | Organization
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Legal Business Name | PENSACOLA MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 01/04/2014
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Last Update Date | 01/04/2014
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Provider Practice Location Address
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Address Line | 2407 W CERVANTES ST
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City | PENSACOLA
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State | FL
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Zip | 32505-7150
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Country | US
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Telephone | 518-867-1551
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Fax |
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Provider Business Mailing Address
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Address Line | 306 GARFIELD DR
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City | PENSACOLA
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State | FL
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Zip | 32505-3614
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Country | US
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Telephone | 518-867-1551
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ALLAN LAM HO
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Credential | MD
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Telephone | 518-867-1551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ACN488
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License Number State | FL
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