Healthcare Provider Details

I. General information

NPI: 1528944980
Provider Name (Legal Business Name): PANAMA CLINIC MEDICAL, S.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO PACIFIC CENTER TORRE B
PANAMA CITY PAITILLA
99999
PA

IV. Provider business mailing address

PO BOX 11661
FORT LAUDERDALE FL
33339-1661
US

V. Phone/Fax

Practice location:
  • Phone: 507-310-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: THEODORO CONSTANTINAU
Title or Position: MGR
Credential:
Phone: 507-310-1111