Provider Demographics
NPI:1750595039
Name:GULF COAST AUDIOLOGY INC
Entity type:Organization
Organization Name:GULF COAST AUDIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCCA
Authorized Official - Phone:727-518-2400
Mailing Address - Street 1:1622 N MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770
Mailing Address - Country:US
Mailing Address - Phone:727-518-2400
Mailing Address - Fax:727-559-8864
Practice Address - Street 1:1622 N MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770
Practice Address - Country:US
Practice Address - Phone:727-518-2400
Practice Address - Fax:727-559-8864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY808237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ0820OtherBLUE CROSS BLUE SHIELD
FLJ0820OtherBLUE CROSS BLUE SHIELD