MEDICARE: PANAMA CITY GENERAL SURGERY PA

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	174400000X	Specialist	0044185	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	24920	OTHER	FL	MEDICARE PTAN NUMBER
4	03619Z	OTHER	FL	MEDICARE PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1457310989	OTHER	FL	NIP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649466137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANAMA CITY GENERAL SURGERY PA

Provider Business Mailing Address
First Line	:	806 E 6TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-3620
Country	:	US
Telephone Number	:	850-763-6224
Fax Number	:	850-872-1623

Provider Business Practice Location Address
First Line	:	806 E 6TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-3620
Country	:	US
Telephone Number	:	850-763-6224
Fax Number	:	850-872-1623

Authorized Official
Title or Position	:	A/R MANAGER
Name	:	MRS. SHARON K BLAIR
Credential	:
Telephone Number	:	850-763-3039

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	04/30/2009

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Directions to “PANAMA CITY GENERAL SURGERY PA ” Practice Location

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