Graceland Family Practice
Clinic/Center, Primary Care in Pensacola, FL. Organization (NPI-2).
NPI number1881293587
StatusActive
Last updated in NPPESOct 22, 2020
Details
- NPI
- 1881293587
- Entity type
- Organization (NPI-2)
- Legal business name
- Graceland Family Practice
- Organization subpart
- No
- Enumeration date
- Oct 22, 2020
- Certification date
- Oct 22, 2020
- Last updated
- Oct 22, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | – | – | Yes |
Practice location
6470 Tippin AvePensacola, FL 32504-8143
Phone 850-741-2878
Mailing address
6470 Tippin AvePensacola, FL 32504-8143
Phone 850-741-2878
Authorized official
Debra Ann Fickling
Provider
8507412878
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