Provider Demographics
NPI:1427174762
Name:MEDICAL PROFESSIONAL AGENCY INC
Entity type:Organization
Organization Name:MEDICAL PROFESSIONAL AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-623-2948
Mailing Address - Street 1:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32572-0893
Mailing Address - Country:US
Mailing Address - Phone:850-623-2948
Mailing Address - Fax:850-626-2734
Practice Address - Street 1:9400 UNIVERSITY PKWY
Practice Address - Street 2:101C
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5752
Practice Address - Country:US
Practice Address - Phone:850-623-2948
Practice Address - Fax:850-626-2734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCC1458OtherRAILROAD MEDICARE
FL254839924Medicaid
FL24847OtherBLUE CROSS BLUE SHIELD
FL=========001OtherHUMANA
FLCC1458OtherRAILROAD MEDICARE