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General NPI Number Information
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NPI Number | 1952770331
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Entity Type | Organization
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Legal Business Name | PANAMA INTERVENTIONAL PAIN MANAGEMENT, LLC
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 651 GRAND PANAMA BLVD STE 106
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-3458
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Country | US
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Telephone | 850-588-6850
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Fax | 850-588-6876
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Provider Business Mailing Address
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Address Line | 651 GRAND PANAMA BLVD STE 106
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-3458
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Country | US
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Telephone | 850-588-6850
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Fax | 850-588-6876
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARGARET I THIRSTON
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Credential | MD
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Telephone | 850-588-6850
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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 | ME100633
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License Number State | FL
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