MAIN STREET MEDICAL CENTER OF CRESTVIEW, PA (NPI# 1619181914) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619181914 |
| Entity Type | Organization |
| Organization Name | MAIN STREET MEDICAL CENTER OF CRESTVIEW, PA |
| Other Organization Name | MAIN STREET MEDICAL CENTER |
| Practice Address |
369 N. Main St. Crestview FL 32536-3541 |
| Practice Telephone | 8503986963 |
| Mailing Telephone | 8503986963 |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2018-06-21 |
| Authorized Official Name | JOSHUA K. KOLMETZ (OWNER) |
| Authorized Official Telephone | 8503986963 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | MEDICARE GROUP PTAN | AI314 | 01 |
| FL | INDIVIDUAL PROVIDER MEDICARE PTAN | A1315Z | 01 |
| FL | INDIVIDUAL PROVIDER PTAN | HR021Z | 01 |
| Other Name | Type Code |
|---|---|
| Main Street Medical Center | Doing Business As Name - Organization |
| Street Address |
369 N. MAIN ST. |
| City | CRESTVIEW |
| State | FL |
| Zip Code | 32536-3541 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831684901 | Eva Maria I Matute | Adult Companion | 6050 Trestle St, Crestview, FL 32536 | 2018-06-29 |
| 1669989232 | Lauren Estep Flowers | Physician Assistant | 550 Redstone Ave W Ste 370, Crestview, FL 32536 | 2018-01-04 |
| 1427444868 | Jessie Huisken | Social Worker | 5890 Saratoga Dr, Crestview, FL 32536 | 2015-04-13 |
| 1679846166 | John D. Carlson Md | Specialist | 492 North Wilson Street, Crestview, FL 32536 | 2012-02-15 |
| 1154609691 | Alternative Living, Inc. | Assisted Living Facility | 603 North Pearl Street, Crestview, FL 32536 | 2011-08-02 |
| 1487821526 | Michael G Foley Md Pa | Internal Medicine | 524 James Lee Blvd W, Crestview, FL 32536 | 2008-05-08 |
| 1184805830 | Advanced Family Medicine Clinic Inc | Family Medicine | 327 Medcrest Drive, Unit A, Crestview, FL 32536 | 2007-11-23 |
| 1164631511 | Caring Hearts Pediatric Extended Care Center, Inc | Clinic/Center | 380 Medcrest Dr, Crestview, FL 32536 | 2007-05-22 |
| 1669697751 | Crestview Chiropractic Clinic, Inc. | Chiropractor | 1078 S. Ferdon Boulevard, Suite A, Crestview, FL 32536 | 2007-04-16 |
| 1457492886 | Roy M Nakaiye | Dentist | 222 Cedar Ave, Crestview, FL 32536 | 2007-02-09 |
| Find all providers in zip 32536 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487821526 | Michael G Foley Md Pa | Internal Medicine | 524 James Lee Blvd W, Crestview, FL 32536 | 2008-05-08 |
| 1124052014 | Abdul Basit Mir | Internal Medicine | 131 E Redstone Ave, Suite 101, Crestview, FL 32539-5326 | 2006-07-10 |
| 1629026133 | Crestview Hospital Corporation | Internal Medicine | 127c E. Redstone Ave, Crestview, FL 32539-5356 | 2006-05-05 |
| 1740257773 | Vicente Arturo Mendez | Internal Medicine | 130 E Redstone Ave, Crestview, FL 32539-5348 | 2006-03-08 |
| 1598766180 | Michael Gillian Foley | Internal Medicine | 524 W James Lee Blvd, Crestview, FL 32536-5129 | 2005-08-03 |
| 1184628802 | Steven Scott Donchey | Internal Medicine | 151 E Redstone Ave, Crestview, FL 32539-5352 | 2005-06-10 |
| 1790116762 | Main Street Medical Center | Internal Medicine | 369 N Main St, Crestview, FL 32536-3541 | 2013-12-02 |
| 1255660775 | Abdul B Mir Md Pa | Internal Medicine | 131 E Redstone Ave, Suite 101, Crestview, FL 32539-5326 | 2009-12-11 |
| 1093971061 | Michael P Roberts Md Pa | Internal Medicine | 369 N Main St, Crestview, FL 32536-3541 | 2008-07-30 |
| 1487833505 | Rasha N. Beg | Internal Medicine | 601 Redstone Ave W, Crestview, FL 32536-6439 | 2007-10-25 |
| Find all providers in CRESTVIEW | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.