Organization
CMS PENSACOLA
Active
Other names
FL DEPT OF HEALTH CMS PENSACOLA
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JEAN DIANE GASTON (PROGRAM ADMINISTRATOR)
(850) 484-5040
Entity
Organization
Contact information
Practice address
5192 BAYOU BLVD, PENSACOLA, FL 32503-2102
(850) 484-5040
(850) 475-5507
Mailing address
5192 BAYOU BLVD, PENSACOLA, FL 32503-2102
(850) 484-5040
(850) 475-5507
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
052490500
—
FL
Enumeration date
01/31/2006
Last updated
04/19/2013
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