Provider Demographics
NPI:1528627882
Name:ANCHOR MULTISPECIALTY GROUP
Entity type:Organization
Organization Name:ANCHOR MULTISPECIALTY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:GROOM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-433-1656
Mailing Address - Street 1:890 S PALAFOX ST UNIT 300
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-5905
Mailing Address - Country:US
Mailing Address - Phone:850-433-1656
Mailing Address - Fax:850-433-1996
Practice Address - Street 1:850 S PALAFOX ST UNIT 103
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5983
Practice Address - Country:US
Practice Address - Phone:850-433-6760
Practice Address - Fax:850-433-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty