Provider Demographics
NPI:1043398621
Name:PANAMA CITY PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:PANAMA CITY PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNGBLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-769-7270
Mailing Address - Street 1:500 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4011
Mailing Address - Country:US
Mailing Address - Phone:850-769-7270
Mailing Address - Fax:850-769-7229
Practice Address - Street 1:500 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4011
Practice Address - Country:US
Practice Address - Phone:850-769-7270
Practice Address - Fax:850-769-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME679032086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27145OtherBCBS
FL27145OtherBCBS
FL27145OtherBCBS
FLF82448Medicare UPIN