Organization
PEDIATRIC PRIMARY CARE FOUNDATION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFERY E BAXLA (PROGRAM ADMINISTRATOR)
(352) 369-7835
Entity
Organization
Contact information
Practice address
1539 NE 22ND AVE, SUITE A, OCALA, FL 34470-4761
(352) 369-7800
(352) 369-2141
Mailing address
1539 NE 22ND AVE, SUITE A, OCALA, FL 34470-4761
(352) 369-7800
(352) 369-2141
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251K00000X
Public Health or Welfare Agency
—
—
251V00000X
Voluntary or Charitable Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
752161800
—
FL
05
—
752161801
—
FL
Enumeration date
01/26/2006
Last updated
02/03/2015
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