| Principle Medical Group, Llc | |
|
7000 Cobble Crk Pensacola FL 32504-8638 | |
| (850) 776-4265 | |
| Not Available |
| Full Name | Principle Medical Group, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 7000 Cobble Crk, Pensacola, Florida |
| Authorized Official Name and Position | Roman S. Bautista (PRESIDENT) |
| Authorized Official Contact | 8507764265 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Principle Medical Group, Llc 7000 Cobble Crk Pensacola FL 32504-8638 Ph: (850) 776-4265 | Principle Medical Group, Llc 7000 Cobble Crk Pensacola FL 32504-8638 Ph: (850) 776-4265 |
| NPI Number | 1407179989 |
|---|---|
| Provider Enumeration Date | 03/11/2010 |
| Last Update Date | 02/13/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407179989 | NPI | - | NPPES |
| 265911500 | Medicaid | FL | |
| 009913418 | Medicaid | AL | |
| 59067672 | Other | AL | BC/BS OF ALABAMA |
| 62842 | Other | FL | BCBS OF FLORIDA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | OS7158 (Florida) | Primary |
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