=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073639472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AKRMP HEARING GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 08/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 RACETRACK RD NW
-----------------------------------------------------
City | FORT WALTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32547-1642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-244-3839
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 RACETRACK RD NW
-----------------------------------------------------
City | FORT WALTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32547-1642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-244-3839
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RICHARD M PERSIANI
-----------------------------------------------------
Credential | BS-HSS, HIS
-----------------------------------------------------
Telephone | 850-585-5515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | AS3573
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------