MEDICARE: PANAMA CITY PPEC, 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
1	3140N1450X	Pediatric Skilled Nursing Facility

Other Identifiers

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

General Provider Information

NPI Number	:	1114529047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANAMA CITY PPEC, LLC

Provider Business Mailing Address
First Line	:	284 FOREST PARK CIR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4921
Country	:	US
Telephone Number	:	850-960-5045
Fax Number	:

Provider Business Practice Location Address
First Line	:	284 FOREST PARK CIR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4921
Country	:	US
Telephone Number	:	850-960-5045
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MOHAMED ABDELLI
Credential	:
Telephone Number	:	850-960-5045

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	11/16/2020

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Directions to “PANAMA CITY PPEC, LLC ” Practice Location

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