| Life Management Center Of Nw Fl, Inc. | |
|
525 East 15th Street Panama City FL 32405-0000 | |
| (850) 522-4485 | |
| (850) 257-7967 |
| Full Name | Life Management Center Of Nw Fl, Inc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 525 East 15th Street, Panama City, Florida |
| Authorized Official Name and Position | Edwin R Ailes (CEO/PRESIDENT) |
| Authorized Official Contact | 8505224485 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Management Center Of Nw Fl, Inc. 525 E 15th St Panama City FL 32405-5412 Ph: (850) 522-4485 | Life Management Center Of Nw Fl, Inc. 525 East 15th Street Panama City FL 32405-0000 Ph: (850) 522-4485 |
| NPI Number | 1508854571 |
|---|---|
| Provider Enumeration Date | 10/12/2005 |
| Last Update Date | 10/10/2024 |
| Certification Date | 10/10/2024 |
| Medicare PECOS PAC ID | 9739162371 |
|---|---|
| Medicare Enrollment ID | O20040612000387 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508854571 | NPI | - | NPPES |
| 99260 | Other | FL | BLUE CROSS BLUE SHIELD |
| 060296500 | Medicaid | FL |
| Provider Name | David K Spillane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881909646 PECOS PAC ID: 5698960573 Enrollment ID: I20111006000649 |
| Provider Name | Angelo P Herbu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265472096 PECOS PAC ID: 3971766528 Enrollment ID: I20120518000419 |
| Provider Name | Phillip Burnett |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699194027 PECOS PAC ID: 3072808930 Enrollment ID: I20160817001835 |
| Provider Name | Barton L Lewis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255397618 PECOS PAC ID: 2062459977 Enrollment ID: I20170509000352 |
| Provider Name | Jennifer S Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801440763 PECOS PAC ID: 3173955903 Enrollment ID: I20191118001126 |
| Provider Name | Rickman G Powers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770985855 PECOS PAC ID: 1254643851 Enrollment ID: I20200324000129 |
| Provider Name | Kevin B Amiri |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013377589 PECOS PAC ID: 1759712052 Enrollment ID: I20200520000720 |
| Provider Name | Cheryl Elder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033725353 PECOS PAC ID: 3173934122 Enrollment ID: I20220624000462 |
| Provider Name | Eleetka C Morrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619697513 PECOS PAC ID: 0345611828 Enrollment ID: I20230119002232 |
| Provider Name | Melanie Mcfarland Spoon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194061622 PECOS PAC ID: 4385909175 Enrollment ID: I20230511003657 |
| Provider Name | Pamela Gilley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851001473 PECOS PAC ID: 3870957715 Enrollment ID: I20230912000999 |
| Provider Name | Melissa Sims |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063093060 PECOS PAC ID: 7810351533 Enrollment ID: I20230914000829 |
| Provider Name | Melissa Chambers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265049670 PECOS PAC ID: 4587013115 Enrollment ID: I20231207004064 |
| Provider Name | Robin Finley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013794924 PECOS PAC ID: 3971952490 Enrollment ID: I20231209000396 |
| Provider Name | Chasity Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619652112 PECOS PAC ID: 1759730187 Enrollment ID: I20231211003685 |
| Provider Name | Laura Swalley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437398146 PECOS PAC ID: 6709235872 Enrollment ID: I20231214001795 |
| Provider Name | Kerrie A Lewis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205221595 PECOS PAC ID: 9830549823 Enrollment ID: I20240103003129 |
| Provider Name | Casey Whitman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1053944124 PECOS PAC ID: 0143671131 Enrollment ID: I20240103003382 |
| Provider Name | Shaun Phelps |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275870495 PECOS PAC ID: 1557712122 Enrollment ID: I20240108004621 |
| Provider Name | Penny Greene |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316196231 PECOS PAC ID: 9537512678 Enrollment ID: I20240125001326 |
| Provider Name | Sonni Sears |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841744489 PECOS PAC ID: 4284087776 Enrollment ID: I20240131004294 |
| Provider Name | Ashley Thornton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811538028 PECOS PAC ID: 3072956986 Enrollment ID: I20240207004269 |
| Provider Name | Dawn N Carissan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134431240 PECOS PAC ID: 0143664276 Enrollment ID: I20240216002419 |
| Provider Name | Elizabeth Lawrence |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437768645 PECOS PAC ID: 2961843529 Enrollment ID: I20240514001026 |
| Provider Name | William Wheaton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548694854 PECOS PAC ID: 7517344377 Enrollment ID: I20240517003143 |
| Provider Name | Anita Dickens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093951105 PECOS PAC ID: 8325414089 Enrollment ID: I20240724004476 |
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