Provider Demographics
NPI:1306068523
Name:AUDIOLOGY CONSULTANTS PA OF PANAMA CITY
Entity type:Organization
Organization Name:AUDIOLOGY CONSULTANTS PA OF PANAMA CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:P
Authorized Official - Last Name:KOLMETZ
Authorized Official - Suffix:
Authorized Official - Credentials:AUD CCCA
Authorized Official - Phone:850-769-2705
Mailing Address - Street 1:2518 S HIGHWAY 77 STE A
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-4730
Mailing Address - Country:US
Mailing Address - Phone:850-769-2705
Mailing Address - Fax:850-769-1097
Practice Address - Street 1:2518 S HIGHWAY 77 STE A
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-4730
Practice Address - Country:US
Practice Address - Phone:850-769-2705
Practice Address - Fax:850-769-1097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY370231H00000X
FLAY1111231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty