Healthcare Provider Details

I. General information

NPI: 1528232170
Provider Name (Legal Business Name): CHARLES R MOREHOUSE AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 UNIVERSITY HALL DRIVE ROOM 120
BOONE NC
28608-2041
US

IV. Provider business mailing address

400 UNIVERSITY HALL DRIVE ROOM 120
BOONE NC
28608-2041
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-2185
  • Fax: 828-262-6766
Mailing address:
  • Phone: 828-262-2185
  • Fax: 828-262-6766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number7415
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: