Healthcare Provider Details

I. General information

NPI: 1619003332
Provider Name (Legal Business Name): MODERN HEARING AID CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 COURT ST N SUITE B
TALLADEGA AL
35160-2013
US

IV. Provider business mailing address

115 COURT ST N SUITE B
TALLADEGA AL
35160-2013
US

V. Phone/Fax

Practice location:
  • Phone: 256-362-0037
  • Fax: 256-362-0911
Mailing address:
  • Phone: 256-362-0037
  • Fax: 256-362-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number0284A
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0284A
License Number StateAL

VIII. Authorized Official

Name: MR. VERNON J BOSARGE
Title or Position: AUDIOLOGIST
Credential:
Phone: 256-362-0037