Organization Active NPI

Hearing Center of Moultrie LLC

  • Audiologist
  • Moultrie, GA
National Provider Identifier
1912379173
Registry record updated Oct 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
AUD003826 Issued in GA
Legal business name
HEARING CENTER OF MOULTRIE LLC
Practice address
27 8TH Ave SE
Moultrie, GA 31768-5500
Phone
(229) 985-3277
Fax
(229) 985-3280
NPI assigned
Oct 28, 2015
Last updated
Oct 28, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Brittany Redfearn
Title
Office Manager
Phone
(229) 985-3277

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X AUD003826 GA Primary

Addresses

Primary practice location

27 8TH Ave SE
Moultrie, GA 31768-5500

Mailing address

27 8TH Ave SE
Moultrie, GA 31768-5500
Phone (229) 985-3277

Other identifiers 1

IdentifierTypeStateIssuer
003165812AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151207002582 GA Part B Supplier - Clinic/Group Practice 8426358847 Receives reassigned benefits from 1 practitioner
Practice locations: Moultrie, GA

National Provider Directory

National Provider Directory

Locations

27 8th Ave SE
Moultrie, GA 31768
Phone (229) 985-3277

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1445990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445990400000",
    "number": "1912379173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 8TH AVE SE",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317685500",
            "telephone_number": "229-985-3277",
            "fax_number": "229-985-3280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 8TH AVE SE",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317685500",
            "telephone_number": "229-985-3277",
            "fax_number": "229-985-3280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARING CENTER OF MOULTRIE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-28",
        "last_updated": "2015-10-28",
        "status": "A",
        "authorized_official_last_name": "REDFEARN",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "229-985-3277",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "GA",
            "license": "AUD003826",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003165812A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moultrie, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.