| Coastline Neuropsychiatric | |
|
890 S Palafox St Suite 300-l Pensacola FL 32502 | |
| (850) 341-4896 | |
| (850) 433-1996 |
| Full Name | Coastline Neuropsychiatric |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 890 S Palafox St Suite 300-l, Pensacola, Florida |
| Authorized Official Name and Position | Kevin Neil Groom (OWNER) |
| Authorized Official Contact | 8503414896 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastline Neuropsychiatric 304 W Gadsden St Pensacola FL 32501 Ph: (850) 341-4896 | Coastline Neuropsychiatric 890 S Palafox St Suite 300-l Pensacola FL 32502 Ph: (850) 341-4896 |
| NPI Number | 1043996986 |
|---|---|
| Provider Enumeration Date | 06/26/2023 |
| Last Update Date | 10/06/2023 |
| Certification Date | 10/06/2023 |
| Medicare PECOS PAC ID | 4284089061 |
|---|---|
| Medicare Enrollment ID | O20231013002536 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043996986 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | Kevin N Groom |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184717027 PECOS PAC ID: 3072417807 Enrollment ID: I20070515000582 |
| Provider Name | Cris W Jagar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538269121 PECOS PAC ID: 9830126820 Enrollment ID: I20130717000718 |
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