Provider Demographics
NPI:1699116079
Name:NEUROPATHY RELIEF CENTER OF PANAMA CITY LLC
Entity type:Organization
Organization Name:NEUROPATHY RELIEF CENTER OF PANAMA CITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MADEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-890-1407
Mailing Address - Street 1:826 HARRISON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2526
Mailing Address - Country:US
Mailing Address - Phone:850-215-2671
Mailing Address - Fax:850-215-2691
Practice Address - Street 1:826 HARRISON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2526
Practice Address - Country:US
Practice Address - Phone:850-215-2671
Practice Address - Fax:850-215-2691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHN056AOtherMEDICARE PTAN (PROVIDER TRANSACTION NUMBER)