Provider Demographics
NPI:1760681548
Name:AUDIOLOGY ASSOCIATES OF SPARTANBURG PA
Entity Type:Organization
Organization Name:AUDIOLOGY ASSOCIATES OF SPARTANBURG PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:WOFFORD
Authorized Official - Last Name:DAWSEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:AUD
Authorized Official - Phone:864-583-7644
Mailing Address - Street 1:410 E HENRY ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302
Mailing Address - Country:US
Mailing Address - Phone:864-583-7644
Mailing Address - Fax:864-583-8118
Practice Address - Street 1:410 E HENRY ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302
Practice Address - Country:US
Practice Address - Phone:864-583-7644
Practice Address - Fax:864-583-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC164231H00000X
SC2352231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2119Medicare PIN