Healthcare Provider Details

I. General information

NPI: 1770944803
Provider Name (Legal Business Name): HEARING HEALTHCARE OF SOUTH CAROLINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 SUNSET BLVD
WEST COLUMBIA SC
29169-6863
US

IV. Provider business mailing address

1175 SUNSET BLVD
WEST COLUMBIA SC
29169-6863
US

V. Phone/Fax

Practice location:
  • Phone: 803-796-2200
  • Fax: 803-796-0740
Mailing address:
  • Phone: 803-796-2200
  • Fax: 803-796-0740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number471
License Number StateSC

VIII. Authorized Official

Name: MR. FERDINAND I LARA
Title or Position: HEARING INSTRUMENT SPECIALIST
Credential: SC HIS 471
Phone: 803-796-2200