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General NPI Number Information
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NPI Number | 1831523612
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Entity Type | Organization
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Legal Business Name | OUR LADY OF ANGELS, ST. JOSEPH MEDICAL CLINIC, INC
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Dates
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Enumeration Date | 08/28/2013
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Last Update Date | 08/30/2013
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Provider Practice Location Address
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Address Line | 131 W. INTENDENCIA ST.
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City | PENSACOLA
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State | FL
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Zip | 32502
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Country | US
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Telephone | 850-434-8162
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Fax | 850-434-8996
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Provider Business Mailing Address
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Address Line | 131 W. INTENDENCIA ST
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City | PENSACOLA
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State | FL
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Zip | 32502
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Country | US
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Telephone | 850-434-8162
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Fax | 850-434-8996
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DAVID CONKLE
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Credential | M.D.
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Telephone | 850-434-8162
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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 |
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License Number State |
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