MEDICARE: HEALTHPOINT MEDICAL GROUP OF PANAMA CITY BEACH

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	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K6505	OTHER		MEDICARE PTAN

General Provider Information

NPI Number	:	1427097880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHPOINT MEDICAL GROUP OF PANAMA CITY BEACH

Provider Business Mailing Address
First Line	:	12234 PANAMA CITY BEACH PARKWAY
Second Line	:	SUITE C
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2700
Country	:	US
Telephone Number	:	850-233-2323
Fax Number	:	850-233-1055

Provider Business Practice Location Address
First Line	:	12234 PANAMA CITY BEACH PARKWAY
Second Line	:	SUITE C
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2700
Country	:	US
Telephone Number	:	850-233-2323
Fax Number	:	850-233-1055

Authorized Official
Title or Position	:	PRES
Name	:	DR. M TERRY ULLMANN
Credential	:	MD
Telephone Number	:	850-233-2323

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	06/08/2010

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