Healthcare Provider Details

I. General information

NPI: 1659620979
Provider Name (Legal Business Name): BELTONE COASTAL CAROLINA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 PHYSICIANS DR SUITE 106
SUPPLY NC
28462-4215
US

IV. Provider business mailing address

640 6TH AVE S
NORTH MYRTLE BEACH SC
29582-3310
US

V. Phone/Fax

Practice location:
  • Phone: 910-754-5227
  • Fax: 910-754-8773
Mailing address:
  • Phone: 843-663-4327
  • Fax: 843-663-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number5508
License Number StateNC

VIII. Authorized Official

Name: KIMBERLY RAE KING
Title or Position: PRESIDENT
Credential: AU.D.
Phone: 843-663-4327