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General NPI Number Information
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NPI Number | 1679386502
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Entity Type | Organization
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Legal Business Name | PANCARE OF FLORIDA, INC
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 1414 MAIN ST
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City | CHIPLEY
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State | FL
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Zip | 32428-6952
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Country | US
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Telephone | 850-676-4926
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Fax | 850-676-4929
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Provider Business Mailing Address
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Address Line | 403 E 11TH ST
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City | PANAMA CITY
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State | FL
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Zip | 32401-3409
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Country | US
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Telephone | 850-747-5599
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Fax | 850-872-4131
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | LAURA RILEY
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Credential |
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Telephone | 850-215-3578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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