MEDICARE: AUDIOLOGY CONSULTANTS PA OF PANAMA CITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	AY370	FL
2	231H00000X	Audiologist	AY1111	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306068523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDIOLOGY CONSULTANTS PA OF PANAMA CITY

Provider Business Mailing Address
First Line	:	2518 S HIGHWAY 77 STE A
Second Line	:
City	:	LYNN HAVEN
State	:	FL
Zip	:	32444-4730
Country	:	US
Telephone Number	:	850-769-2705
Fax Number	:	850-769-1097

Provider Business Practice Location Address
First Line	:	2518 S HIGHWAY 77 STE A
Second Line	:
City	:	LYNN HAVEN
State	:	FL
Zip	:	32444-4730
Country	:	US
Telephone Number	:	850-769-2705
Fax Number	:	850-769-1097

Authorized Official
Title or Position	:	OWNER AND AUDIOLOGIST
Name	:	MR. MARCUS P KOLMETZ
Credential	:	AUD CCCA
Telephone Number	:	850-769-2705

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	05/08/2018

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Directions to “AUDIOLOGY CONSULTANTS PA OF PANAMA CITY ” Practice Location

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