MEDICARE: NAVAL DIVING & SALVAGE TRAINING CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QE0002X	Emergency Care Clinic/Center
2	2865M2000X	Military General Acute Care Hospital
3	305S00000X	Point of Service
4	286500000X	Military Hospital

General Provider Information

NPI Number	:	1437496916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAVAL DIVING & SALVAGE TRAINING CENTER

Provider Business Mailing Address
First Line	:	350 SOUTH CRAG ROAD
Second Line	:	NAVAL DIVING & SALVAGE TRAINING CENTER
City	:	PANAMA CITY
State	:	FL
Zip	:	32407-7018
Country	:	US
Telephone Number	:	850-235-5218
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 CRAG RD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32407-7013
Country	:	US
Telephone Number	:	850-235-5218
Fax Number	:

Authorized Official
Title or Position	:	DEEP SEA INDEPENDENT DUTY CORPSMAN
Name	:	ANGELO LUIS SANCHEZ JR.
Credential	:	IDC
Telephone Number	:	850-235-5215

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	01/03/2013

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