Organization
PANTHER EMERGENCY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER PROVASNIK (SUPERVISOR OF PROVIDER ENROLLMENT)
(800) 355-0808
Entity
Organization
Contact information
Practice address
1395 S PINELLAS AVE, TARPON SPRINGS, FL 34689-3790
(727) 942-5002
Mailing address
PO BOX 8126, PHILADELPHIA, PA 19101-8126
(800) 355-0808
(215) 834-2862
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38658
BLUE SHIELD
FL
01
—
CG9999
RAILROAD MEDICARE
FL
Enumeration date
07/05/2007
Last updated
04/20/2008
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