Provider Demographics
NPI:1770631301
Name:DANIEL ISLAND HEARING CENTER LLC
Entity Type:Organization
Organization Name:DANIEL ISLAND HEARING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-971-4199
Mailing Address - Street 1:899 ISLAND PARK DR
Mailing Address - Street 2:200A
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8112
Mailing Address - Country:US
Mailing Address - Phone:843-971-4199
Mailing Address - Fax:843-971-4292
Practice Address - Street 1:899 ISLAND PARK DR
Practice Address - Street 2:200A
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-8112
Practice Address - Country:US
Practice Address - Phone:843-971-4199
Practice Address - Fax:843-971-4292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3069231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4287Medicaid
SCQ3236358273Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER