Provider Demographics
NPI:1548690936
Name:PENSACOLA HOUSE CALLS,LLC
Entity type:Organization
Organization Name:PENSACOLA HOUSE CALLS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAST
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:850-377-5268
Mailing Address - Street 1:5040 YESTEROAKS CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-4316
Mailing Address - Country:US
Mailing Address - Phone:850-377-5268
Mailing Address - Fax:850-474-1892
Practice Address - Street 1:5040 YESTEROAKS CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-4316
Practice Address - Country:US
Practice Address - Phone:850-377-5268
Practice Address - Fax:850-474-1892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1962363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty