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General NPI Number Information
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NPI Number | 1003269630
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Entity Type | Organization
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Legal Business Name | GULF COAST PAIN CONSULTANTS PLLC
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 4901 GRANDE DR STE A
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City | PENSACOLA
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State | FL
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Zip | 32504-5936
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Country | US
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Telephone | 850-484-4080
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Fax |
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Provider Business Mailing Address
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Address Line | 201 DEFENSE HWY STE 205
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7096
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Country | US
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Telephone | 855-527-7246
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | KACEY A MONTGOMERY
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Credential | MD
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Telephone | 850-791-6895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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