Provider Demographics
NPI:1003589151
Name:GULF COAST HEARING LLC
Entity Type:Organization
Organization Name:GULF COAST HEARING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:HAS, BC-HIS
Authorized Official - Phone:850-819-1240
Mailing Address - Street 1:2232 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2158
Mailing Address - Country:US
Mailing Address - Phone:850-784-4327
Mailing Address - Fax:850-784-0060
Practice Address - Street 1:2232 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2158
Practice Address - Country:US
Practice Address - Phone:850-784-4327
Practice Address - Fax:850-784-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1467592501OtherTIM SMITH NPI