Provider Demographics
NPI:1134366305
Name:DOCTORS HEARING CARE CENTER, LLC
Entity type:Organization
Organization Name:DOCTORS HEARING CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:GIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:252-355-0909
Mailing Address - Street 1:2140 W ARLINGTON BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5709
Mailing Address - Country:US
Mailing Address - Phone:252-355-0909
Mailing Address - Fax:252-355-1899
Practice Address - Street 1:2140 W ARLINGTON BLVD STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5709
Practice Address - Country:US
Practice Address - Phone:252-355-0909
Practice Address - Fax:252-355-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC#640261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC012EPOtherBLUE CROSS/ BLUE SHIELD OF NC
NC3404215Medicaid