Healthcare Provider Details

I. General information

NPI: 1689645145
Provider Name (Legal Business Name): CMS PANAMA CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N TYNDALL PKWY
PANAMA CITY FL
32404-6432
US

IV. Provider business mailing address

230 N TYNDALL PKWY
PANAMA CITY FL
32404-6432
US

V. Phone/Fax

Practice location:
  • Phone: 850-872-4700
  • Fax: 850-872-4817
Mailing address:
  • Phone: 850-872-4700
  • Fax: 850-872-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JEAN D GASTON
Title or Position: PROGRAM ADMINISTRATOR
Credential:
Phone: 850-484-5040