OrganizationAvalon Medical GroupNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1900 Summit Blvd, Pensacola, FL 32503-3359(850) 436-5900(850) 476-4200PECOS EnrollmentBased on the most recent information from CMS, provider Avalon Medical Group does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1558531905Provider TypeOrganizationFull NameAvalon Medical GroupSubpartNoEnumeration Date3/1/2008Last Updated7/6/2012Contact InformationPractice LocationPractice Address1900 Summit Blvd, Pensacola, FL 32503-3359Phone(850) 436-5900FaxUnlisted FaxMailing LocationMailing AddressPO Box 10209, Pensacola, FL 32524-0209Phone(850) 476-4200Fax(866) 684-0566Authorized OfficialNameStanley, Katherine K (Authorized Agent)Phone(850) 485-7341Provider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID00A0PDescriptionOtherIssuerBLUE CROSS BLUE SHIELD OF FLORIDAFloridaID001078000DescriptionMedicaidIssuerUnlistedFlorida