Provider Demographics
NPI:1720299233
Name:JC AUDIOLOGY INC
Entity Type:Organization
Organization Name:JC AUDIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:813-949-1331
Mailing Address - Street 1:1541 DALE MABRY HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-3017
Mailing Address - Country:US
Mailing Address - Phone:813-949-1331
Mailing Address - Fax:813-949-6132
Practice Address - Street 1:1541 DALE MABRY HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-3017
Practice Address - Country:US
Practice Address - Phone:813-949-1331
Practice Address - Fax:813-949-6132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY902237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS9144OtherBCBS
FL600472500Medicaid
FL600472500Medicaid