Healthcare Provider's Profile
| Full Name | |
|---|
| Type | Facility |
|---|
| Speciality | Clinic/center |
|---|
| Location | 916 E Fairfield Dr, Pensacola, Florida |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1780610238
- Provider Enumeration Date: 06/25/2006
- Last Update Date: 02/16/2023
Medical Identifiers
Medical identifiers for
such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1780610238 | NPI | - | NPPES |
| 811296700 | Medicaid | FL | |
| 880208400 | Medicaid | FL | |
| Y906N | Other | FL | BLUE CROSS BLUE SHEILD |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 235Z00000X | Speech-language Pathologist | (* (Not Available)) | Secondary |
| 252Y00000X | Early Intervention Provider Agency | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
3932 N 10th Ave,
Pensacola, FL 32503-2807
Ph: (850) 434-7755 |
916 E Fairfield Dr,
Pensacola, FL 32503-2817
Ph: (850) 434-7755 |
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