Lakeside Audiology Llc is a medicare enrolled "Clinic/center - Hearing And Speech" provider in Fort Mill, South Carolina. Their current practice location is
870 Gold Hill Rd Ste 104, Fort Mill, South Carolina. You can reach out to their office (for appointments etc.) via phone at
(803) 620-8250.
Lakeside Audiology Llc is licensed to practice in South Carolina (license number 4011) and it also participates in the medicare program. Lakeside Audiology Llc
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1417341280.
Healthcare Provider's Profile
| Full Name | Lakeside Audiology Llc |
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| Type | Facility |
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| Speciality | Clinic/center - Hearing And Speech |
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| Location | 870 Gold Hill Rd Ste 104, Fort Mill, South Carolina |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1417341280
- Provider Enumeration Date: 03/19/2015
- Last Update Date: 11/19/2021
Medicare PECOS Information:
- PECOS PAC ID: 3870812159
- Enrollment ID: O20150508000250
Medical Identifiers
Medical identifiers for Lakeside Audiology Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1417341280 | NPI | - | NPPES |
| SA1525 | Medicaid | SC | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 231H00000X | Audiologist | (* (Not Available)) | Secondary |
| 235Z00000X | Speech-language Pathologist | (* (Not Available)) | Secondary |
| 261QH0700X | Clinic/center - Hearing And Speech | 4011 (South Carolina) | Primary |
| 261QH0700X | Clinic/center - Hearing And Speech | 9758 (North Carolina) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Lakeside Audiology Llc acts as a billing entity for following providers:
| Provider Name | Kimberly Block |
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| Provider Type | Practitioner - Qualified Audiologist |
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| Provider Identifiers | NPI Number: 1831317767
PECOS PAC ID: 5698937514
Enrollment ID: I20150508000296 |
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| Provider Name | Meghan K Jensen |
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| Provider Type | Practitioner - Qualified Audiologist |
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| Provider Identifiers | NPI Number: 1255484549
PECOS PAC ID: 9931276383
Enrollment ID: I20170413000364 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Lakeside Audiology Llc is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Lakeside Audiology Llc
870 Gold Hill Rd Ste 104,
Fort Mill, SC 29708-8988
Ph: (803) 620-8250 | Lakeside Audiology Llc
870 Gold Hill Rd Ste 104,
Fort Mill, SC 29708-8988
Ph: (803) 620-8250 |
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