Provider Demographics
NPI:1760793343
Name:COASTAL HEARING CENTERS, INC
Entity Type:Organization
Organization Name:COASTAL HEARING CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:EVANS
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:910-671-5014
Mailing Address - Street 1:PO BOX 4868
Mailing Address - Street 2:
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467-1068
Mailing Address - Country:US
Mailing Address - Phone:910-671-5014
Mailing Address - Fax:910-608-0269
Practice Address - Street 1:2298 OCEAN HWY
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462
Practice Address - Country:US
Practice Address - Phone:910-755-2428
Practice Address - Fax:910-608-0269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1102261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404235Medicaid