Provider Demographics
NPI:1952770331
Name:PANAMA INTERVENTIONAL PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:PANAMA INTERVENTIONAL PAIN MANAGEMENT, LLC
Other - Org Name:DR. MARGARET I. THIRSTON
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:I
Authorized Official - Last Name:THIRSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-588-6850
Mailing Address - Street 1:651 GRAND PANAMA BLVD
Mailing Address - Street 2:STE 106
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-3458
Mailing Address - Country:US
Mailing Address - Phone:850-588-6850
Mailing Address - Fax:850-588-6876
Practice Address - Street 1:651 GRAND PANAMA BLVD
Practice Address - Street 2:STE 106
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-3458
Practice Address - Country:US
Practice Address - Phone:850-588-6850
Practice Address - Fax:850-588-6876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100633207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty