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General NPI Number Information
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NPI Number | 1891354007
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Entity Type | Organization
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Legal Business Name | GULF COAST PAIN CONSULTANTS LLC
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 2507 HARRISON AVE UNIT 200
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City | PANAMA CITY
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State | FL
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Zip | 32405-4447
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Country | US
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Telephone | 855-527-7246
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Fax | 866-229-5063
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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 | 833-810-1165
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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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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