LAKESIDE AUDIOLOGY LLC NPI 1417341280

NPI Information

NPI: 1417341280
Provider Name: LAKESIDE AUDIOLOGY LLC
Classification: Clinic/Center - 261QH0700X
Specialization: Hearing and Speech
Entity Type: Organization
Address: 870 GOLD HILL RD STE 104
FORT MILL, SC
ZIP 29708
Phone: (803) 620-8250

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NPI Details

LAKESIDE AUDIOLOGY LLC is a hearing and speech clinic center in Fort Mill, SC. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, prescriptive, and therapy services related to congenital and acquired conditions and diseases that affect hearing capacity and speech ability. LAKESIDE AUDIOLOGY LLC NPI is 1417341280. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

870 GOLD HILL RD STE 104
FORT MILL, SC
ZIP 29708-988
Phone: (803) 620-8250
Fax: (803) 638-6901

The provider's authorized official is Kimberly Block .
The authorized official title is Doctor Of Audiology and has the following contact phone number (803) 412-6789.

The enumeration date for this NPI number is 3/19/2015 and was last updated on 11/19/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	231H00000X	Audiologist				No
2	235Z00000X	Speech-Language Pathologist				No
3	261QH0700X	Clinic/Center	Hearing and Speech	9758	NORTH CAROLINA	No
4	261QH0700X	Clinic/Center	Hearing and Speech	4011	SOUTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	SA1525	MEDICAID	SOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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