MEDICARE: WOLFE & WOLFE ENTERPRISES INC

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	261Q00000X	Clinic/Center	ARNP3417872	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1013007723	OTHER	FL	NPI

General Provider Information

NPI Number	:	1639490642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOLFE & WOLFE ENTERPRISES INC

Provider Business Mailing Address
First Line	:	220 HARMON AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-5801
Country	:	US
Telephone Number	:	850-814-8400
Fax Number	:	850-215-8405

Provider Business Practice Location Address
First Line	:	100 DOCTORS DR
Second Line	:	SUITE C
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-7608
Country	:	US
Telephone Number	:	850-814-8400
Fax Number	:	850-747-8836

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. WANEDA KAY WOLFE
Credential	:	ARNP
Telephone Number	:	850-814-8400

Provider Enumeration Date	:	06/14/2010
Last Update Date	:	06/16/2010

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