Provider Demographics
NPI:1316929458
Name:RUNYAN, CAROL REID (AUD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:REID
Last Name:RUNYAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3405
Mailing Address - Country:US
Mailing Address - Phone:800-328-8602
Mailing Address - Fax:
Practice Address - Street 1:701 N STATE OF FRANKLIN RD STE 5
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3645
Practice Address - Country:US
Practice Address - Phone:423-928-9285
Practice Address - Fax:423-328-0795
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001303231H00000X
TNA0000001097231H00000X
237700000X
VA2101001591237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3967003Medicare UPIN
TN3967003Medicare ID - Type Unspecified