Main Street Medical Center

NPI #1790116762 in Crestview, Florida

Provider Information

NPI Number: 1790116762
Entity Type: Organization
Organization Name: Main Street Medical Center
Primary Specialty: Internal Medicine
Enumeration Date: Dec 2, 2013
Last Updated: Dec 2, 2013

Practice Location

Address: 369 N MAIN ST
City: Crestview
State: Florida
ZIP Code: 32536-3541
Phone: (850) 398-6963

Authorized Official

Name: DR. JOSHUA K KOLMETZ, M.D.
Title: PRESIDENT
Phone: (850) 398-6963

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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