Provider Demographics
NPI:1700938545
Name:ADVANCED AUDIOLOGY & HEARING AIDS, INC.
Entity Type:Organization
Organization Name:ADVANCED AUDIOLOGY & HEARING AIDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:843-663-4327
Mailing Address - Street 1:640 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3310
Mailing Address - Country:US
Mailing Address - Phone:843-663-4327
Mailing Address - Fax:843-663-3277
Practice Address - Street 1:640 6TH AVE S
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3310
Practice Address - Country:US
Practice Address - Phone:843-663-4327
Practice Address - Fax:843-663-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3045237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0405Medicaid
SC05127OtherBLUE CROSS BLUE SHIELD
SC87726OtherUNITED HEALTHCARE
SC640004274Medicare ID - Type UnspecifiedRAILROAD MEDICARE
SCA356Medicare UPIN