Provider Demographics
NPI:1891940490
Name:BEACHSIDE HEARING
Entity Type:Organization
Organization Name:BEACHSIDE HEARING
Other - Org Name:EARCARE PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COWAN-OBERBECK
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, FAAA, CCC-A
Authorized Official - Phone:321-752-4552
Mailing Address - Street 1:1875 S PATRICK DR STE D
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4330
Mailing Address - Country:US
Mailing Address - Phone:321-777-7113
Mailing Address - Fax:321-777-9131
Practice Address - Street 1:1875 S PATRICK DR STE D
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4330
Practice Address - Country:US
Practice Address - Phone:321-777-7113
Practice Address - Fax:321-777-9131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EARCARE PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY145231H00000X
FLAS3781237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR73918Medicare UPIN