Organization
BEACHSIDE PEDIATRIC ASSOCIATES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLAYTON COVELL LANCASTER (PROJECT MANAGER)
(850) 758-8331
Entity
Organization
Contact information
Practice address
490 HIGHWAY 85 N, NICEVILLE, FL 32578-1010
(850) 419-2691
(850) 353-2142
Mailing address
1590 RUCKEL DR, NICEVILLE, FL 32578-1603
(850) 621-5058
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
12/10/2020
Last updated
01/21/2021
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