Provider Demographics
NPI:1831191907
Name:SUMTER HEARING ASSOCIATES
Entity type:Organization
Organization Name:SUMTER HEARING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CASTE
Authorized Official - Suffix:
Authorized Official - Credentials:BSBA
Authorized Official - Phone:803-469-7770
Mailing Address - Street 1:1116 ALICE DR
Mailing Address - Street 2:STE F
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1941
Mailing Address - Country:US
Mailing Address - Phone:803-469-7770
Mailing Address - Fax:803-469-7701
Practice Address - Street 1:1116 ALICE DR
Practice Address - Street 2:STE F
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1941
Practice Address - Country:US
Practice Address - Phone:803-469-7770
Practice Address - Fax:803-469-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC377231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3636Medicaid
SCSA0179Medicaid
SCSA0049Medicaid
SCGP3636Medicaid
SCSA0049Medicaid