Provider Demographics
NPI:1891704961
Name:ANCLOTE HEARING CENTERS, INC
Entity Type:Organization
Organization Name:ANCLOTE HEARING CENTERS, INC
Other - Org Name:SOUTHGATE HEARING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLADWIN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:727-849-6076
Mailing Address - Street 1:5139 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-3966
Mailing Address - Country:US
Mailing Address - Phone:727-849-6076
Mailing Address - Fax:727-848-2830
Practice Address - Street 1:5139 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3966
Practice Address - Country:US
Practice Address - Phone:727-849-6076
Practice Address - Fax:727-848-2830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1140231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK323Medicare ID - Type UnspecifiedAUDIOLOGY CLINIC