MEDICARE: DR. GARY FIKE JR. AUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	5785	NC
2	237600000X	Audiologist-Hearing Aid Fitter	1077	NC
3	237600000X	Audiologist-Hearing Aid Fitter	3913	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P01285347	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0024571	OTHER		CIGNA
2	1629T	OTHER	NC	BCBSNC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	9066225	OTHER		AENTA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	30105375	OTHER	SC	SELECT HEALTH OF SC

General Provider Information

NPI Number	:	1588836720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY FIKE JR. AUD

Provider Business Mailing Address
First Line	:	127 BEN CASEY DR.
Second Line	:	SUITE 105
City	:	FORT MILL
State	:	SC
Zip	:	29708-8557
Country	:	US
Telephone Number	:	803-547-4327
Fax Number	:	803-547-4329

Provider Business Practice Location Address
First Line	:	127 BEN CASEY DR.
Second Line	:	SUITE 105
City	:	FORT MILL
State	:	SC
Zip	:	29708-8557
Country	:	US
Telephone Number	:	803-547-4327
Fax Number	:	803-547-4329

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	07/29/2015

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Directions to “ DR. GARY FIKE JR. AUD” Practice Location

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