Provider Demographics
NPI:1730843442
Name:UPSTATE HEARING AND BALANCE LLC
Entity type:Organization
Organization Name:UPSTATE HEARING AND BALANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILES JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:803-528-7069
Mailing Address - Street 1:9 CARRONBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-6818
Mailing Address - Country:US
Mailing Address - Phone:803-528-7069
Mailing Address - Fax:
Practice Address - Street 1:25 WOODS LAKE RD STE 401
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2763
Practice Address - Country:US
Practice Address - Phone:803-528-7069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty