Basic Information
| Provider Information | |||||||||
| NPI: | 1881674257 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FIRST PHYSICIANS GROUP PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 18868 | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325238868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509945660 | ||||||||
| FaxNumber: | 8599945841 | ||||||||
| Practice Location | |||||||||
| Address1: | 3802 HIGHWAY 90 | ||||||||
| Address2: | |||||||||
| City: | PACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325711014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509945660 | ||||||||
| FaxNumber: | 8509945841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 10/12/2009 | ||||||||
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| AuthorizedOfficialLastName: | BAISDEN | ||||||||
| AuthorizedOfficialFirstName: | KYLIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 8509945660 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 261372508 | 05 | FL | MEDICAID | 261372505 | 05 | FL | MEDICAID | 261372506 | 05 | FL | MEDICAID | 263172510 | 05 | FL | MEDICAID | 608177300 | 01 | FL | US DEPARTMENT OF LABOR | OTHER | CA7660 | 01 | FL | RAILROAD MEDICARE | OTHER | 0582 | 01 | FL | HEALTHY KIDS | OTHER | 263172501 | 05 | FL | MEDICAID | 38502 | 01 | FL | BLUE CROSS BLUE SHIELD FL | OTHER | 261372500 | 05 | FL | MEDICAID | 261372502 | 05 | FL | MEDICAID | 261372509 | 05 | FL | MEDICAID | 263172503 | 05 | FL | MEDICAID | 0582 | 01 | FL | HEALTH OPTIONS | OTHER | 261372507 | 05 | FL | MEDICAID |