Provider Demographics
NPI:1780723569
Name:ANDERSON AUDIOLOGY CONSULTANTS, PA
Entity type:Organization
Organization Name:ANDERSON AUDIOLOGY CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:864-222-0059
Mailing Address - Street 1:101 BROADBENT WAY
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625
Mailing Address - Country:US
Mailing Address - Phone:864-222-0059
Mailing Address - Fax:864-222-9008
Practice Address - Street 1:101 BROADBENT WAY
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625
Practice Address - Country:US
Practice Address - Phone:864-222-0059
Practice Address - Fax:864-222-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC2405231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0500Medicaid
SC7425Medicare ID - Type UnspecifiedPROVIDER NUMBER