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Organization
MAIN STREET MEDICAL CENTER OF CRESTVIEW, PA
Active
Organization
MAIN STREET MEDICAL CENTER OF CRESTVIEW, PA
Active
Other names
Main Street Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA K. KOLMETZ MD (OWNER)
(850) 398-6963
Entity
Organization
Contact information
Practice address
369 N. MAIN ST., CRESTVIEW, FL 32536-3541
(850) 398-6963
Mailing address
369 N. MAIN ST., CRESTVIEW, FL 32536-3541
(850) 398-6963
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A1315Z
INDIVIDUAL PROVIDER MEDICARE PTAN
FL
01
—
AI314
MEDICARE GROUP PTAN
FL
01
—
HR021Z
INDIVIDUAL PROVIDER PTAN
FL
Enumeration date
05/09/2007
Last updated
06/21/2018
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