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NPI Code Detail

MEDICARE: SEAGRASS PCB MC, LLC

MEDICARE: SEAGRASS PCB MC, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003374455
Entity Type Code : Organization
Provider Name (Legal Business Name) : SEAGRASS PCB MC, LLC
Provider Business Mailing Address
First Line : 2528 BARRINGTON CIR STE 2
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-3888
Country : US
Telephone Number : 850-583-7990
Fax Number :
Provider Business Practice Location Address
First Line : 401 N ALF COLEMAN RD
Second Line :
City : PANAMA CITY BEACH
State : FL
Zip : 32407-2567
Country : US
Telephone Number : 850-249-0707
Fax Number :
Authorized Official
Title or Position : CFO
Name : SETH WALKER
Credential :
Telephone Number : 850-583-7990
Provider Enumeration Date : 03/05/2019
Last Update Date : 03/02/2023

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Directions to “SEAGRASS PCB MC, LLC ” Practice Location

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