Provider Demographics
NPI:1528308962
Name:ABC MEDICAL HOUSE CALLS, INC.
Entity type:Organization
Organization Name:ABC MEDICAL HOUSE CALLS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:850-549-1387
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:GONZALEZ
Mailing Address - State:FL
Mailing Address - Zip Code:32560-1030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8596 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-3345
Practice Address - Country:US
Practice Address - Phone:850-549-1387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty