Basic Information
| Provider Information | |||||||||
| NPI: | 1568587715 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDLAND HEARING ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 WELLNESS BLVD | ||||||||
| Address2: | SUITE108 | ||||||||
| City: | IRMO | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290632871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037651919 | ||||||||
| FaxNumber: | 8037493371 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 RICHLAND MEDICAL PARK DR | ||||||||
| Address2: | SUITE130 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292036849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037651919 | ||||||||
| FaxNumber: | 8037719084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 10/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | TODD | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANGER | ||||||||
| AuthorizedOfficialTelephone: | 8037651919 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | GP0844 | 05 | SC | MEDICAID |