Provider Demographics
NPI:1689645145
Name:CMS PANAMA CITY
Entity Type:Organization
Organization Name:CMS PANAMA CITY
Other - Org Name:FL DEPT OF HEALTH PANAMA CITY
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-484-5040
Mailing Address - Street 1:230 N TYNDALL PKWY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-6432
Mailing Address - Country:US
Mailing Address - Phone:850-872-4700
Mailing Address - Fax:850-872-4817
Practice Address - Street 1:230 N TYNDALL PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-6432
Practice Address - Country:US
Practice Address - Phone:850-872-4700
Practice Address - Fax:850-872-4817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052562600Medicaid