| Main Street Medical Center | |
|
369 N. Main St. Crestview FL 32536-3541 | |
| (850) 398-6963 | |
| Not Available |
| Full Name | Main Street Medical Center |
|---|---|
| Speciality | Internal Medicine |
| Location | 369 N. Main St., Crestview, Florida |
| Authorized Official Name and Position | Joshua K. Kolmetz (OWNER) |
| Authorized Official Contact | 8503986963 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Medical Center 369 N. Main St. Crestview FL 32536-3541 Ph: (850) 398-6963 | Main Street Medical Center 369 N. Main St. Crestview FL 32536-3541 Ph: (850) 398-6963 |
| NPI Number | 1619181914 |
|---|---|
| Provider Enumeration Date | 05/09/2007 |
| Last Update Date | 06/21/2018 |
| Medicare PECOS PAC ID | 2264518943 |
|---|---|
| Medicare Enrollment ID | O20080320000224 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619181914 | NPI | - | NPPES |
| AI314 | Other | FL | MEDICARE GROUP PTAN |
| HR021Z | Other | FL | INDIVIDUAL PROVIDER PTAN |
| A1315Z | Other | FL | INDIVIDUAL PROVIDER MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Joshua K Kolmetz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699862599 PECOS PAC ID: 0345338786 Enrollment ID: I20071119000016 |
| Provider Name | Jonathan D Aspinwall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063804722 PECOS PAC ID: 3476864661 Enrollment ID: I20150615000950 |
| Provider Name | Lindsay K Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235852757 PECOS PAC ID: 1355719675 Enrollment ID: I20221117001891 |
| Provider Name | John Cuthriell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235991506 PECOS PAC ID: 1557708872 Enrollment ID: I20240322000801 |
| Provider Name | Taylor Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508309501 PECOS PAC ID: 2163704594 Enrollment ID: I20240607002708 |
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Marcene F. Kreifels, M.d., P.a. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1198 S Ferdon Blvd, Crestview, FL 32536 Phone: 850-682-1735 Fax: 850-689-4400 | |
Michael P Roberts Md Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 369 N Main St, Crestview, FL 32536 Phone: 850-398-6963 Fax: 850-398-8277 | |
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