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General NPI Number Information
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NPI Number | 1366203655
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Entity Type | Organization
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Legal Business Name | PANHANDLE DIAGNOSTICS LLC
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 502 S MAIN ST
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City | CRESTVIEW
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State | FL
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Zip | 32536-4250
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Country | US
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Telephone | 850-401-2418
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Fax |
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Provider Business Mailing Address
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Address Line | 5736 GRIFFITH CEMETERY RD
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City | BAKER
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State | FL
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Zip | 32531-8402
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Country | US
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Telephone | 850-401-2418
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KELLEY BROOKE MOSS
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Credential | RDMS/RVT
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Telephone | 850-398-0108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number |
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License Number State |
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