Healthcare Provider Details

I. General information

NPI: 1689487563
Provider Name (Legal Business Name): PANCARE OF FLORIDA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12427 HIGHWAY 231
YOUNGSTOWN FL
32466-2562
US

IV. Provider business mailing address

403 E 11TH ST
PANAMA CITY FL
32401-3409
US

V. Phone/Fax

Practice location:
  • Phone: 850-753-3246
  • Fax: 850-753-3342
Mailing address:
  • Phone: 850-747-5599
  • Fax: 850-874-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: LAURA RILEY
Title or Position: BILLING MANAGER
Credential:
Phone: 850-215-3578