Basic Information
| Provider Information | |||||||||
| NPI: | 1205226289 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COASTAL HEARING AND BALANCE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ASCENT AUDIOLOGY AND HEARING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 101 LOTTIE LN STE 2 | ||||||||
| Address2: | |||||||||
| City: | FAIRHOPE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365327309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2519900535 | ||||||||
| FaxNumber: | 2519900538 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 LOTTIE LN STE 2 | ||||||||
| Address2: | |||||||||
| City: | FAIRHOPE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365327309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2519900535 | ||||||||
| FaxNumber: | 2519900538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2015 | ||||||||
| LastUpdateDate: | 01/21/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TUBERTINI | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2515506514 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | AU.D. | ||||||||
| NPICertificationDate: | 01/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | N | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist | 332S00000X | N | Suppliers | Hearing Aid Equipment | 261QH0700X | 0983A | AL | Y | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech |
No ID Information.