| Hwy 90 Pediatrics | |
|
4435 Highway 90 Pace FL 32571 | |
| (850) 436-4630 | |
| (850) 436-2095 |
| Full Name | Hwy 90 Pediatrics |
|---|---|
| Speciality | Clinic/Center |
| Location | 4435 Highway 90, Pace, 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 |
|---|---|
| Hwy 90 Pediatrics 2315 W Jackson St Pensacola FL 32505-7552 Ph: (850) 436-4630 | Hwy 90 Pediatrics 4435 Highway 90 Pace FL 32571 Ph: (850) 436-4630 |
| NPI Number | 1033601794 |
|---|---|
| Provider Enumeration Date | 05/30/2018 |
| Last Update Date | 11/30/2018 |
| Medicare PECOS PAC ID | 9638165806 |
|---|---|
| Medicare Enrollment ID | O20190108004144 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033601794 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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