Provider Demographics
NPI:1215003553
Name:AUDIOSCOPE AUDIOLOGY GROUP APC
Entity type:Organization
Organization Name:AUDIOSCOPE AUDIOLOGY GROUP APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-279-6772
Mailing Address - Street 1:2815 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3815
Mailing Address - Country:US
Mailing Address - Phone:858-279-6772
Mailing Address - Fax:858-279-7505
Practice Address - Street 1:2815 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3815
Practice Address - Country:US
Practice Address - Phone:858-279-6772
Practice Address - Fax:858-279-7505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGAU000040Medicaid
CAGAU000040Medicaid