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NPI Code Detail

MEDICARE: CLEARWAY SURGERY CENTER OF PANAMA CITY, LLC

MEDICARE: CLEARWAY SURGERY CENTER OF PANAMA CITY, 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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1316599624
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLEARWAY SURGERY CENTER OF PANAMA CITY, LLC
Provider Business Mailing Address
First Line : 201 DEFENSE HWY STE 205
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21401-7096
Country : US
Telephone Number : 855-527-7246
Fax Number : 833-810-1165
Provider Business Practice Location Address
First Line : 1600 JENKS AVE STE 1
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4644
Country : US
Telephone Number : 850-484-4080
Fax Number : 850-484-8801
Authorized Official
Title or Position : REGIONAL MEDICAL DIRECTOR
Name : KACEY A MONTGOMERY
Credential : M.D.
Telephone Number : 850-791-6895
Provider Enumeration Date : 07/16/2019
Last Update Date : 05/17/2022

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