Provider Demographics
NPI:1801982863
Name:CHARLOTTE HEARING CENTER, INC.
Entity type:Organization
Organization Name:CHARLOTTE HEARING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:941-766-8886
Mailing Address - Street 1:21216 OLEAN BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6722
Mailing Address - Country:US
Mailing Address - Phone:941-766-8886
Mailing Address - Fax:941-766-8804
Practice Address - Street 1:21216 OLEAN BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6722
Practice Address - Country:US
Practice Address - Phone:941-766-8886
Practice Address - Fax:941-766-8804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY211231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCJ2976OtherR.R. MEDICARE
FLJ0825OtherBLUE CROSS/BLUE SHIELD
FLT0849OtherBLUECROSS/BLUE SHIELD
FLK3047Medicare ID - Type Unspecified