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NPI Code Detail

MEDICARE: 3611 TRANSMITTER INC

MEDICARE: 3611 TRANSMITTER 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1629156138
Entity Type Code : Organization
Provider Name (Legal Business Name) : 3611 TRANSMITTER INC
Provider Business Mailing Address
First Line : 3611 TRANSMITTER RD
Second Line :
City : PANAMA CITY
State : FL
Zip : 32404-9799
Country : US
Telephone Number : 850-747-9688
Fax Number : 850-747-9992
Provider Business Practice Location Address
First Line : 3611 TRANSMITTER RD
Second Line :
City : PANAMA CITY
State : FL
Zip : 32404-9799
Country : US
Telephone Number : 850-747-9688
Fax Number : 850-747-9992
Authorized Official
Title or Position : MANAGER
Name : SHELBY PARKER
Credential :
Telephone Number : 850-747-9688
Provider Enumeration Date : 11/01/2006
Last Update Date : 12/09/2013

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