1710070974 NPI number — CHARLOTTE AUDIOLOGY SERVICES

Table of content: (NPI 1710070974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710070974 NPI number — CHARLOTTE AUDIOLOGY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLOTTE AUDIOLOGY SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HEARING CARE SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710070974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1928 RANDOLPH RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28207-1105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-377-0375
Provider Business Mailing Address Fax Number:
704-342-4737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1928 RANDOLPH RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28207-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-377-0375
Provider Business Practice Location Address Fax Number:
704-342-4737
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DOWD
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
ROSE
Authorized Official Title or Position:
OWNER AUDIOLOGIST
Authorized Official Telephone Number:
704-377-0375

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  1661 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2343353 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 740123X , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: SAN034 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4543021 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6278199002 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NPA642 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37287 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0123X . This is a "BCBS GROUP #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5926060 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: A1494 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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