Healthcare Provider Details

I. General information

NPI: 1548305428
Provider Name (Legal Business Name): CENTRAL CAROLINA AUDIOLOGICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 BETHESDA RD STE 100
WINSTON SALEM NC
27103-3301
US

IV. Provider business mailing address

751 BETHESDA RD STE 100
WINSTON SALEM NC
27103-3301
US

V. Phone/Fax

Practice location:
  • Phone: 336-774-1113
  • Fax: 336-774-1467
Mailing address:
  • Phone: 336-774-1113
  • Fax: 336-774-1467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2601
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2601
License Number StateNC

VIII. Authorized Official

Name: TRINA BEDSAUL
Title or Position: DOCTOR OF AUDIOLOGY
Credential: AU.D.
Phone: 336-774-1113