Provider Demographics
NPI:1326378282
Name:PANHANDLE FAMILY MEDICINE, PA
Entity type:Organization
Organization Name:PANHANDLE FAMILY MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AYSHIA
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MSM
Authorized Official - Phone:850-638-4555
Mailing Address - Street 1:877 3RD ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-1827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:877 3RD ST
Practice Address - Street 2:SUITE 4
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-1827
Practice Address - Country:US
Practice Address - Phone:850-638-4555
Practice Address - Fax:850-638-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLW2DOtherBCBS FACILITY