Provider Demographics
NPI:1639563620
Name:PALMETTO FAMILY HEARING CENTER, LLC
Entity Type:Organization
Organization Name:PALMETTO FAMILY HEARING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FIKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:AUD
Authorized Official - Phone:803-547-4327
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3913261QH0700X
NC5785261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech