Pea Ridge Family Care Center Inc

NPI 1306822911 - Family Medicine - 207Q00000X

NPI Details
NPI 1306822911
Enumeration Date 12/16/2005
Last Updated 12/12/2011
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name PURUSHOTTAM K. PURUSHOTTAM
Position OWNER
Phone (850) 995-8811
Fax (850) 995-8810
Practice Location
5553 HIGHWAY 90
PACE FL, 32571-1540, US
Phone (850) 995-8811
Fax (850) 995-8810
Business Location
PO BOX 2276
PENSACOLA FL, 32513-2276, US
Phone (850) 995-8811
Fax (850) 995-8810
Toxanomy
Taxonomy Code 207Q00000X
License State
License Number
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According to our database, Pea Ridge Family Care Center Inc NPI is 1306822911, taxonomy code is 207Q00000X Pea Ridge Family Care Center Inc physically located at 5553 Highway 90, Pace FL, 32571-1540. NPI Number 1033115704 has the healthcare provider type.

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1306822911 NPI number is provided on an as is basis without warranty of any kind. 1306822911 is maintained by the National Plan & Provider Enumeration System. The contents of Pea Ridge Family Care Center Inc are for informational purposes only.