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6021 Industrial Blvd Century FL 32535 | |
(850) 724-4064 | |
(850) 436-2095 |
Full Name | |
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Speciality | Clinic/Center |
Location | 6021 Industrial Blvd, Century, Florida |
Authorized Official Name and Position | Chandra Smiley (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 8504364630 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2315 W Jackson St Pensacola FL 32505-7552 Ph: (850) 436-4630 | 6021 Industrial Blvd Century FL 32535 Ph: (850) 724-4064 |
NPI Number | 1952822173 |
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Provider Enumeration Date | 06/28/2017 |
Last Update Date | 11/30/2018 |
Medicare PECOS PAC ID | 9638165806 |
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Medicare Enrollment ID | O20171030002835 |
Identifier | Type | State | Issuer |
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1952822173 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Mayo Street Medical, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7600 Mayo St Ste A, Century, FL 32535 Phone: 888-517-4992 Fax: 252-377-4231 | |