MEDICARE: JOURNEYPURE PANHANDLE MEDICAL GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RA0401X	Addiction Medicine (Internal Medicine) Physician	59359	FL

General Provider Information

NPI Number	:	1033567268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEYPURE PANHANDLE MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	22219 PANAMA CITY BEACH PKWY
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32413-3227
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22219 PANAMA CITY BEACH PKWY
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32413-3227
Country	:	US
Telephone Number	:	850-249-4300
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OP RCM
Name	:	KATHERINE BOWERS
Credential	:
Telephone Number	:	615-715-4214

Provider Enumeration Date	:	05/27/2016
Last Update Date	:	03/20/2026

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