Healthcare Provider Details

I. General information

NPI: 1891940490
Provider Name (Legal Business Name): BEACHSIDE HEARING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 S PATRICK DR STE D
INDIAN HARBOUR BEACH FL
32937-4330
US

IV. Provider business mailing address

1875 S PATRICK DR STE D
INDIAN HARBOUR BEACH FL
32937-4330
US

V. Phone/Fax

Practice location:
  • Phone: 321-777-7113
  • Fax: 321-777-9131
Mailing address:
  • Phone: 321-777-7113
  • Fax: 321-777-9131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY145
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS3781
License Number StateFL

VIII. Authorized Official

Name: DR. CATHERINE COWAN-OBERBECK
Title or Position: PRESIDENT
Credential: AUD, FAAA, CCC-A
Phone: 321-752-4552