NPIMap

Organization Active NPI

Gulf Coast Medical Center Primary Care LLC

  • Obstetrics & Gynecology Physician
  • Panama City, FL
National Provider Identifier
1285679050
Registry record updated May 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
GULF COAST MEDICAL CENTER PRIMARY CARE LLC
Practice address
2202 State Ave
Ste. 207
Panama City, FL 32405-7601
Phone
(850) 784-2645
Fax
(850) 784-2646
NPI assigned
Jun 17, 2006
Last updated
May 24, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mickey Pickler
Title
VP
Phone
(850) 229-8288

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X NU Primary

Addresses

Primary practice location

2202 State Ave
Ste. 207
Panama City, FL 32405-7601

Mailing address

2202 State Ave
Ste. 207
Panama City, FL 32405-7601
Phone (850) 784-2645

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070530000114 FL Part B Supplier - Clinic/Group Practice 0648288589 Receives reassigned benefits from 6 practitioners
Practice locations: Panama City, FL

National Provider Directory

National Provider Directory

Locations

2202 State Ave
Ste 207
Panama City, FL 32405
Phone (850) 784-1856

300 Long Ave
Port St Joe, FL 32456
Phone (305) 229-8348

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306195200000",
    "number": "1285679050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 STATE AVE",
            "address_2": "STE. 207",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324057601",
            "telephone_number": "850-784-2645",
            "fax_number": "850-784-2646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 STATE AVE",
            "address_2": "STE. 207",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324057601",
            "telephone_number": "850-784-2645",
            "fax_number": "850-784-2646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST MEDICAL CENTER PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2011-05-24",
        "status": "A",
        "authorized_official_last_name": "PICKLER",
        "authorized_official_first_name": "MICKEY",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "850-229-8288"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Panama City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.