Provider Demographics
NPI:1821082405
Name:UNIVERSITY OF NORTH CAROLINA AT GREENSBORO
Entity Type:Organization
Organization Name:UNIVERSITY OF NORTH CAROLINA AT GREENSBORO
Other - Org Name:SPEECH AND HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:G
Authorized Official - Last Name:FOX-THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-256-1496
Mailing Address - Street 1:PO BOX 26170
Mailing Address - Street 2:300 FERGUSON BLDG
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27402-6170
Mailing Address - Country:US
Mailing Address - Phone:336-334-5939
Mailing Address - Fax:336-334-4475
Practice Address - Street 1:524 HIGHLAND AVE
Practice Address - Street 2:300 FERGUSON BLDG
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27412-5018
Practice Address - Country:US
Practice Address - Phone:336-334-5939
Practice Address - Fax:336-334-4475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0240COtherBLUE CROSS BLUE SHEILD
NC740240CMedicaid