Provider Demographics
NPI:1659620979
Name:BELTONE COASTAL CAROLINA, LLC
Entity Type:Organization
Organization Name:BELTONE COASTAL CAROLINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:843-663-4327
Mailing Address - Street 1:640 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3310
Mailing Address - Country:US
Mailing Address - Phone:843-663-4327
Mailing Address - Fax:843-663-3277
Practice Address - Street 1:58 PHYSICIANS DR
Practice Address - Street 2:SUITE 106
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4215
Practice Address - Country:US
Practice Address - Phone:910-754-5227
Practice Address - Fax:910-754-8773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5508332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment