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General NPI Number Information
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NPI Number | 1740627165
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Entity Type | Organization
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Legal Business Name | BEACH MEDICAL EXPRESS LLC
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Dates
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Enumeration Date | 05/24/2013
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Last Update Date | 05/24/2013
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Provider Practice Location Address
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Address Line | 108 CAPE CIR
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32413-5206
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Country | US
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Telephone | 850-532-3430
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Fax |
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Provider Business Mailing Address
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Address Line | 9952 HUTCHISON BLVD
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407
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Country | US
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Telephone | 850-588-5689
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | VIRGINIA PULLEN
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Credential | PA-C
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Telephone | 850-588-5689
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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 | PA 9104277
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License Number State | FL
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