MEDICARE: CHARLOTTE AUDIOLOGY SERVICES

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	231H00000X	Audiologist	1661	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2343353	OTHER	NC	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4543021	OTHER		UNITED HEALTHCARE
5	6278199002	OTHER	NC	CIGNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	37287	OTHER	NC	PARTNERS
8	0123X	OTHER	NC	BCBS GROUP #
9	5926060	OTHER	NC	AETNA
10	A1494	OTHER	NC	MEDCOST

General Provider Information

NPI Number	:	1710070974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLOTTE AUDIOLOGY SERVICES

Provider Business Mailing Address
First Line	:	1928 RANDOLPH RD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28207-1105
Country	:	US
Telephone Number	:	704-377-0375
Fax Number	:	704-342-4737

Provider Business Practice Location Address
First Line	:	1928 RANDOLPH RD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28207-1105
Country	:	US
Telephone Number	:	704-377-0375
Fax Number	:	704-342-4737

Authorized Official
Title or Position	:	OWNER AUDIOLOGIST
Name	:	MRS. KATHY ROSE DOWD
Credential	:	CCC-A
Telephone Number	:	704-377-0375

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/20/2008

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Directions to “CHARLOTTE AUDIOLOGY SERVICES ” Practice Location

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