MEDICARE: CAROLINA FOREST HEARING CENTER OF SC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist

General Provider Information

NPI Number	:	1528823978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA FOREST HEARING CENTER OF SC LLC

Provider Business Mailing Address
First Line	:	3885 RENEE DR STE 102
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4372
Country	:	US
Telephone Number	:	843-903-0635
Fax Number	:	843-903-0636

Provider Business Practice Location Address
First Line	:	3885 RENEE DR STE 102
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4372
Country	:	US
Telephone Number	:	843-903-0635
Fax Number	:	843-903-0636

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOSHUA VAN NESS
Credential	:	HAS
Telephone Number	:	843-903-0635

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/15/2024

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