Provider Demographics
NPI:1710070974
Name:CHARLOTTE AUDIOLOGY SERVICES
Entity Type:Organization
Organization Name:CHARLOTTE AUDIOLOGY SERVICES
Other - Org Name:HEARING CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:DOWD
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-A
Authorized Official - Phone:704-377-0375
Mailing Address - Street 1:1928 RANDOLPH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1105
Mailing Address - Country:US
Mailing Address - Phone:704-377-0375
Mailing Address - Fax:704-342-4737
Practice Address - Street 1:1928 RANDOLPH RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1105
Practice Address - Country:US
Practice Address - Phone:704-377-0375
Practice Address - Fax:704-342-4737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1661231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2343353OtherAETNA
NC740123XMedicaid
SCSAN034Medicaid
4543021OtherUNITED HEALTHCARE
NC6278199002OtherCIGNA
SCNPA642Medicaid
NC37287OtherPARTNERS
NC0123XOtherBCBS GROUP #
NC5926060OtherAETNA
NCA1494OtherMEDCOST
SCSAN034Medicaid
NC5926060OtherAETNA