Organization
GULF COAST PAIN CONSULTANTS LLC
Active
Other names
Clearway Pain Solutions Institute
Organization subpart
No
Provider details
NPI number
Authorized official
KACEY A MONTGOMERY MD (REGIONAL MEDICAL DIRECTOR)
(850) 791-6895
Entity
Organization
Contact information
Practice address
918 MAR WALT DR, FORT WALTON BEACH, FL 32547-6706
(855) 527-7246
(833) 905-2461
Mailing address
201 DEFENSE HWY STE 205, ANNAPOLIS, MD 21401-7096
(855) 527-7246
(866) 229-5063
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/03/2024
Last updated
06/03/2024
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