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General NPI Number Information
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NPI Number | 1285256974
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Entity Type | Organization
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Legal Business Name | COASTAL HEARING & BALANCE SOLUTIONS LLC
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Dates
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Enumeration Date | 05/15/2020
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 1139 FIRST COLONIAL RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-2402
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Country | US
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Telephone | 757-453-1160
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Fax |
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Provider Business Mailing Address
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Address Line | 1139 FIRST COLONIAL RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-2402
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Country | US
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Telephone | 757-453-1160
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIMBERLY C SPARKS
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Credential | AU.D.
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Telephone | 757-453-1160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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