Provider Demographics
NPI:1588836720
Name:FIKE, GARY JR (AUD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:FIKE
Suffix:JR
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 BEN CASEY DR.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8557
Mailing Address - Country:US
Mailing Address - Phone:803-547-4327
Mailing Address - Fax:803-547-4329
Practice Address - Street 1:127 BEN CASEY DR.
Practice Address - Street 2:SUITE 105
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8557
Practice Address - Country:US
Practice Address - Phone:803-547-4327
Practice Address - Fax:803-547-4329
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5785231H00000X
NC1077237600000X
SC3913237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0024571OtherCIGNA
NC1629TOtherBCBSNC
NC7413287Medicaid
9066225OtherAENTA
NCP01285347OtherRAILROAD MEDICARE
SCSAN076Medicaid
SC30105375OtherSELECT HEALTH OF SC
SCQ376035874Medicare PIN
NC7413287Medicaid