MEDICARE: BRANCH MEDICAL CLINIC PANAMA CITY

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
1	261QM1100X	Military/U.S. Coast Guard Outpatient Clinic/Center

General Provider Information

NPI Number	:	1114117173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANCH MEDICAL CLINIC PANAMA CITY

Provider Business Mailing Address
First Line	:	6000 W HIGHWAY 98
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32512-0001
Country	:	US
Telephone Number	:	850-505-6309
Fax Number	:	850-505-6908

Provider Business Practice Location Address
First Line	:	6703 W HIGHWAY 98
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32407-7000
Country	:	US
Telephone Number	:	850-234-4177
Fax Number	:

Authorized Official
Title or Position	:	BUMED UBO
Name	:	WILLIAM M CONDON
Credential	:
Telephone Number	:	240-401-3643

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	11/14/2017

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Directions to “BRANCH MEDICAL CLINIC PANAMA CITY ” Practice Location

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