Healthcare Provider Details

I. General information

NPI: 1003589151
Provider Name (Legal Business Name): GULF COAST HEARING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 SAINT ANDREWS BLVD
PANAMA CITY FL
32405-2158
US

IV. Provider business mailing address

2232 SAINT ANDREWS BLVD
PANAMA CITY FL
32405-2158
US

V. Phone/Fax

Practice location:
  • Phone: 850-784-4327
  • Fax: 850-784-0060
Mailing address:
  • Phone: 850-784-4327
  • Fax: 850-784-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY B SMITH
Title or Position: PRESIDENT
Credential: HAS, BC-HIS
Phone: 850-819-1240