Organization
FIRST PHYSICIANS GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLIE BAISDEN (CREDENTIALING)
(850) 994-5660
Entity
Organization
Contact information
Practice address
3802 HIGHWAY 90, PACE, FL 32571-1014
(850) 994-5660
(850) 994-5841
Mailing address
PO BOX 18868, PENSACOLA, FL 32523-8868
(850) 994-5660
(859) 994-5841
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0582
HEALTHY KIDS
FL
05
—
261372500
—
FL
05
—
261372502
—
FL
05
—
261372505
—
FL
05
—
261372506
—
FL
05
—
261372507
—
FL
05
—
261372508
—
FL
05
—
261372509
—
FL
05
—
263172501
—
FL
05
—
263172503
—
FL
05
—
263172510
—
FL
01
—
38502
BLUE CROSS BLUE SHIELD FL
FL
01
—
608177300
US DEPARTMENT OF LABOR
FL
01
—
CA7660
RAILROAD MEDICARE
FL
Enumeration date
01/20/2006
Last updated
10/12/2009
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