Active NPI
Mieko Tanaka, AU.D.
- Audiologist
- Fayetteville, NC
National Provider Identifier
1124010053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 4646
- Practice address
- 955 Fairfield Rd
Fayetteville, NC 28303-5358 - Phone
- (910) 323-9196
- Fax
- (910) 323-9867
- NPI assigned
- Aug 17, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 4646 | NC | Primary |
Addresses
Primary practice location
955 Fairfield Rd
Fayetteville, NC 28303-5358
Mailing address
955 Fairfield Rd
Fayetteville, NC 28303-5358
Phone (910) 323-9196
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3404172 | Medicaid | NC | |
| 89569 | Other | NC | MEDCOST |
| 12393 | Other | NC | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4646 | NC | MD | Rehabilitation Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188950400000",
"number": "1124010053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "955 FAIRFIELD RD",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283035358",
"telephone_number": "910-323-9196",
"fax_number": "910-323-9867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "955 FAIRFIELD RD",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283035358",
"telephone_number": "910-323-9196",
"fax_number": "910-323-9867"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANAKA",
"first_name": "MIEKO",
"name_prefix": "Dr.",
"credential": "AU.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-17",
"last_updated": "2007-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "NC",
"license": "4646",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3404172",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "89569",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "12393",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.