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General NPI Number Information
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NPI Number | 1720571524
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Entity Type | Organization
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Legal Business Name | UPSTATE FAMILY HEARING CARE LLC
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 1109C E RUTHERFORD ST
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City | LANDRUM
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State | SC
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Zip | 29356-1728
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Country | US
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Telephone | 864-457-5827
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Fax |
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Provider Business Mailing Address
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Address Line | 1109C E RUTHERFORD ST
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City | LANDRUM
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State | SC
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Zip | 29356-1728
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Country | US
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Telephone | 864-457-5827
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Fax |
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Authorized Official
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Title or Position | MEMBER LLC
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Name | MR. JEREMY JOHN LAFEBRE
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Credential | HIS
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Telephone | 864-457-5827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | HAS-0581
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License Number State | SC
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