=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801231683
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST CHOICE AUDIOLOGY OF SOUTH FLORIDA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2013
-----------------------------------------------------
Last Update Date | 05/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 WORTH AVE STE 201
-----------------------------------------------------
City | PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33480-4650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-315-6378
-----------------------------------------------------
Fax | 561-833-5825
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 WORTH AVE STE 201
-----------------------------------------------------
City | PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33480-4650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MINDY MARTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-315-6378
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------