Provider Demographics
NPI:1548305428
Name:CENTRAL CAROLINA AUDIOLOGICAL ASSOCIATES INC
Entity type:Organization
Organization Name:CENTRAL CAROLINA AUDIOLOGICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDSAUL
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:336-774-1113
Mailing Address - Street 1:751 BETHESDA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3301
Mailing Address - Country:US
Mailing Address - Phone:336-774-1113
Mailing Address - Fax:336-774-1467
Practice Address - Street 1:751 BETHESDA RD STE 100
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3301
Practice Address - Country:US
Practice Address - Phone:336-774-1113
Practice Address - Fax:336-774-1467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2601332B00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211385Medicaid
NC0126VOtherBLUE CROSS BLUE SHIELD #
246885167Medicare ID - Type UnspecifiedMEDICARE #