Provider Demographics
NPI:1790161669
Name:GRAND STRAND HEARING
Entity Type:Organization
Organization Name:GRAND STRAND HEARING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMMI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GRAY STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-732-6090
Mailing Address - Street 1:1016 2ND AVE N
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3287
Mailing Address - Country:US
Mailing Address - Phone:843-732-6090
Mailing Address - Fax:843-491-3573
Practice Address - Street 1:1016 2ND AVE N
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3287
Practice Address - Country:US
Practice Address - Phone:843-732-6090
Practice Address - Fax:843-491-3573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP072Medicaid