Healthcare Provider Details

I. General information

NPI: 1588836720
Provider Name (Legal Business Name): GARY FIKE JR. AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 BEN CASEY DR. SUITE 105
FORT MILL SC
29708-8557
US

IV. Provider business mailing address

127 BEN CASEY DR. SUITE 105
FORT MILL SC
29708-8557
US

V. Phone/Fax

Practice location:
  • Phone: 803-547-4327
  • Fax: 803-547-4329
Mailing address:
  • Phone: 803-547-4327
  • Fax: 803-547-4329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5785
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1077
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number3913
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: