# PEDIATRIC PRIMARY CARE FOUNDATION, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770553018
- **Authorized official:** JEFFERY E BAXLA (PROGRAM ADMINISTRATOR)
- **Authorized official phone:** (352) 369-7835

## Contact information

- **Practice address:** 1539 NE 22ND AVE, SUITE A, OCALA, FL 34470-4761
- **Practice address phone:** (352) 369-7800
- **Practice address fax:** (352) 369-2141
- **Mailing address:** 1539 NE 22ND AVE, SUITE A, OCALA, FL 34470-4761
- **Mailing address phone:** (352) 369-7800
- **Mailing address fax:** (352) 369-2141

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | NULL | Yes |
| 251K00000X | Public Health or Welfare Agency | — | NULL | — |
| 251V00000X | Voluntary or Charitable Agency | — | NULL | — |

## Other

- **Enumeration date:** 01/26/2006
- **Last updated:** 02/03/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 752161800 | — | FL |
| 05 | — | 752161801 | — | FL |