Provider Demographics
NPI:1356614143
Name:SOUTH COAST HEARING CENTER
Entity type:Organization
Organization Name:SOUTH COAST HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:541-435-0850
Mailing Address - Street 1:1957 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2040
Mailing Address - Country:US
Mailing Address - Phone:541-435-0850
Mailing Address - Fax:541-435-0851
Practice Address - Street 1:1957 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2040
Practice Address - Country:US
Practice Address - Phone:541-435-0850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22938332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment