Provider Demographics
NPI:1114175023
Name:WALSER INC. D/B/A AVADA HEARING CENTER
Entity Type:Organization
Organization Name:WALSER INC. D/B/A AVADA HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHIRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-878-4327
Mailing Address - Street 1:9632 N KINGS HWY
Mailing Address - Street 2:#B12
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4006
Mailing Address - Country:US
Mailing Address - Phone:843-449-2308
Mailing Address - Fax:
Practice Address - Street 1:9632 N KINGS HWY
Practice Address - Street 2:#B12
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4006
Practice Address - Country:US
Practice Address - Phone:843-449-2308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALSER INC. D/B/A AVADA AUDIOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTP760332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment