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General NPI Number Information
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NPI Number | 1871815340
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Entity Type | Organization
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Legal Business Name | GADSDEN FAMILY CLINIC, PA
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Dates
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Enumeration Date | 02/24/2010
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Last Update Date | 06/23/2011
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Provider Practice Location Address
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Address Line | 304 E JEFFERSON ST
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City | QUINCY
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State | FL
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Zip | 32351-2530
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Country | US
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Telephone | 850-875-2125
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Fax | 850-875-4689
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Provider Business Mailing Address
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Address Line | 304 E JEFFERSON ST
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City | QUINCY
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State | FL
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Zip | 32351-2530
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Country | US
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Telephone | 850-875-2125
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Fax | 850-875-4689
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Authorized Official
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Title or Position | CEO
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Name | DR. GLORIA CAMACHO RAMOS
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Credential | M.D.
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Telephone | 850-875-2125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | ME 0029888
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License Number State | FL
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