MEDICARE: PANCARE OF FLORIDA, INC

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1588477475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANCARE OF FLORIDA, INC

Provider Business Mailing Address
First Line	:	403 E 11TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-3409
Country	:	US
Telephone Number	:	850-747-5599
Fax Number	:	850-874-4131

Provider Business Practice Location Address
First Line	:	479 STATE HIGHWAY 20 E
Second Line	:
City	:	FREEPORT
State	:	FL
Zip	:	32439-3931
Country	:	US
Telephone Number	:	850-880-6568
Fax Number	:	850-880-6583

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	LAURA RILEY
Credential	:
Telephone Number	:	850-215-3578

Provider Enumeration Date	:	01/27/2025
Last Update Date	:	01/27/2025

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Directions to “PANCARE OF FLORIDA, INC ” Practice Location

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