1508857228 NPI number — HEARING CARE CENTER

Table of content: (NPI 1508857228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508857228 NPI number — HEARING CARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARING CARE CENTER
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:
Provider Other Organization Name Type Code:
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:
1508857228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3111 MAPLEWOOD AVE
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27103-3906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-659-9569
Provider Business Mailing Address Fax Number:
336-768-8379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3111 MAPLEWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-3906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-659-9569
Provider Business Practice Location Address Fax Number:
336-768-8379
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
REXRODE
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
336-659-9569

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  4289 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 231H00000X , with the licence number: 6712 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: 598 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 045HV . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7640200 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2723795 . This is a "AETRNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7211722 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: #01629 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 42343 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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