MR. PHILLIP WAYNE BLAICH (NPI# 1861458424) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861458424 |
| Entity Type | Individual |
| Full Name | MR. PHILLIP WAYNE BLAICH |
| Credential | PA-C |
| Practice Address |
2905 Highway 77 Panama City FL 32405 |
| Mailing Address |
Po Box 11407 Birmingham AL 35246-1431 |
| Practice Telephone | 8507472220 |
| Practice Fax Number | 8507472222 |
| Mailing Telephone | 8507472220 |
| Mailing Fax Number | 8507472222 |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2018-07-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
085003348 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA9103668 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 020471300 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1021 Harding St, Fairfield, IL 628371208 | 6188424617 | 6188424743 |
| Street Address |
2905 HIGHWAY 77 |
| City | PANAMA CITY |
| State | FL |
| Zip Code | 32405 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679027254 | Janie Pitts | Nurse Practitioner | 2905 Highway 77, Panama City, FL 32405-5013 | 2016-08-11 |
| 1629448543 | Tiffany Brenda Joy Roberts | Nurse Practitioner | 2905 Highway 77, Panama City, FL 32405-5013 | 2015-10-05 |
| 1134569049 | Rainbow Pediatrics PC LLC | Pediatrics | 2905 Highway 77, Panama City, FL 32405-5013 | 2013-06-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457962136 | Kimberlea Fox | Behavioral Analyst | 4750 Collegiate Drive, Technology Building 157, Panama City, FL 32405 | 2020-08-14 |
| 1598325714 | Covenant Home Health Care, LLC | Home Health | 107 W. 19th Street, Panama City, FL 32405 | 2019-06-19 |
| 1467921403 | Amy Hancock | Counselor | 1212 W. 19th St., Panama City, FL 32405 | 2018-11-20 |
| 1063991917 | Patricia Kagendo Mutunga | Day Training, Developmentally Disabled Services | 2813 Fairmont Dr, Panama City, FL 32405 | 2018-08-11 |
| 1871087882 | Southeastern Dermatology Group Pa | Pharmacy | 2505 Harrison Ave Ste A, Panama City, FL 32405 | 2018-06-22 |
| 1346733615 | Jessica Nicole Graham | Nurse Practitioner | 2507 Harrison Ave Unit 101, Panama City, FL 32405 | 2018-06-12 |
| 1437658424 | Coastal Mobility Transportation, LLC | Non-emergency Medical Transport (VAN) | 203 Forest Park Circle, Panama City, FL 32405 | 2018-02-06 |
| 1003314915 | The Anti-aging Clinic of Northwest Florida | Obstetrics & Gynecology | 3019 Osprey Cir, Panama City, FL 32405 | 2018-01-25 |
| 1255848487 | Sarah Theriot | Social Worker | 700 W 23rd St Bldg H, Panama City, FL 32405 | 2018-01-09 |
| 1336686054 | Angela Leake | Registered Nurse | 449 W 23 St, Panama City, FL 32405 | 2017-01-20 |
| Find all providers in zip 32405 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265872766 | Emily Marie Heaton | Physician Assistant | 1931 N Cove Blvd, Panama City, FL 32405-5314 | 2013-06-28 |
| 1265652929 | William Robert Wright | Physician Assistant | 3230b E 15th St, Panama City, FL 32405-7423 | 2007-04-26 |
| 1801939137 | Laura Lea Nofal | Physician Assistant | 2202 State Ave Ste 201, Panama City, FL 32405-4582 | 2007-02-15 |
| 1164403390 | Angela Marie Danley | Physician Assistant | 2505 Harrison Ave, Panama City, FL 32405-4423 | 2005-11-05 |
| 1992328363 | Kaitlyn Taylor Girard | Physician Assistant | 1827 Harrison Ave, Panama City, FL 32405-7605 | 2020-05-20 |
| 1457878985 | Julia Rose Niehl | Physician Assistant | 1514 W 23rd St, Panama City, FL 32405-2905 | 2017-08-25 |
| 1184172967 | Bryan Brinson | Physician Assistant | 615 N Bonita Ave, Panama City, FL 32401-3623 | 2016-09-21 |
| 1255707535 | Amanda Garner | Physician Assistant | 2103 Jenks Ave, Panama City, FL 32405-4511 | 2015-08-20 |
| 1043619315 | Erin Elizabeth Cummings | Physician Assistant | 621 W Baldwin Rd, Suite A, Panama City, FL 32405-3364 | 2014-08-22 |
| 1659609063 | Heidi Goodwiller Barr | Physician Assistant | 4121 W Highway 98, Panama City, FL 32401-1170 | 2009-11-23 |
| Find all providers in PANAMA CITY | ||||
| City | PANAMA CITY |
| Zip Code | 32405 |
Please comment or provide details below to improve the information on MR. PHILLIP WAYNE BLAICH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.