Provider Demographics
NPI:1538604509
Name:EAST HILL MEDICAL GROUP
Entity type:Organization
Organization Name:EAST HILL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-943-9954
Mailing Address - Street 1:99 S ALCANIZ ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-8002
Mailing Address - Country:US
Mailing Address - Phone:850-437-0035
Mailing Address - Fax:850-429-0005
Practice Address - Street 1:99 S ALCANIZ ST STE B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-8002
Practice Address - Country:US
Practice Address - Phone:850-437-0035
Practice Address - Fax:850-429-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10642111N00000X
FLME80025208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1740285006Medicaid
FL1740285006Medicaid
FL1295906493Medicare PIN