Provider Demographics
NPI:1164403713
Name:AUDIOLOGY CONSULTANTS OF SW FL
Entity Type:Organization
Organization Name:AUDIOLOGY CONSULTANTS OF SW FL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF AUDIOLOGY
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:H
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC A
Authorized Official - Phone:238-772-0940
Mailing Address - Street 1:625 DEL PRADO BLVD
Mailing Address - Street 2:#3
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990
Mailing Address - Country:US
Mailing Address - Phone:239-772-0940
Mailing Address - Fax:239-574-2621
Practice Address - Street 1:625 DEL PRADO BLVD
Practice Address - Street 2:#3
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990
Practice Address - Country:US
Practice Address - Phone:239-772-0940
Practice Address - Fax:239-574-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA4-274231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
J0369OtherBCBS
50637OtherBCBS
50637OtherBCBS