Healthcare Provider Details

I. General information

NPI: 1508857228
Provider Name (Legal Business Name): HEARING CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 MAPLEWOOD AVE SUITE 107
WINSTON SALEM NC
27103-3906
US

IV. Provider business mailing address

3111 MAPLEWOOD AVE SUITE 107
WINSTON SALEM NC
27103-3906
US

V. Phone/Fax

Practice location:
  • Phone: 336-659-9569
  • Fax: 336-768-8379
Mailing address:
  • Phone: 336-659-9569
  • Fax: 336-768-8379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number598
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number6712
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4289
License Number StateNC

VIII. Authorized Official

Name: CAROL M REXRODE
Title or Position: OWNER
Credential:
Phone: 336-659-9569