Basic Information
| Provider Information | |||||||||
| NPI: | 1013367549 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE ANCHOR CLINIC, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 890 S PALAFOX ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325025904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504331656 | ||||||||
| FaxNumber: | 8504331996 | ||||||||
| Practice Location | |||||||||
| Address1: | 7552 NAVARRE PKWY UNIT 54 | ||||||||
| Address2: | |||||||||
| City: | NAVARRE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325667305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506843884 | ||||||||
| FaxNumber: | 8504331996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2016 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | GROOM | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | NEIL | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8504331656 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | ARNP9337357 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.