MEDICARE: AMIKIDS PANAMA CITY MARINE INSTITUTE, INC

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	101YM0800X	Mental Health Counselor	MH10807	FL

General Provider Information

NPI Number	:	1114318573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMIKIDS PANAMA CITY MARINE INSTITUTE, INC

Provider Business Mailing Address
First Line	:	200 E BEACH DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-3117
Country	:	US
Telephone Number	:	850-258-1670
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 E BEACH DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-3117
Country	:	US
Telephone Number	:	850-258-1670
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. RON BOYCE
Credential	:
Telephone Number	:	850-872-4715

Provider Enumeration Date	:	02/06/2015
Last Update Date	:	02/06/2015

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