Healthcare Provider Details

I. General information

NPI: 1982987103
Provider Name (Legal Business Name): TRI-COUNTY AUDIOLOGY AND HEARING AID SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3519 N LECANTO HWY
BEVERLY HILLS FL
34465-3501
US

IV. Provider business mailing address

3519 N LECANTO HWY
BEVERLY HILLS FL
34465-3501
US

V. Phone/Fax

Practice location:
  • Phone: 352-746-1133
  • Fax: 352-746-3474
Mailing address:
  • Phone: 352-746-1133
  • Fax: 352-746-3474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberAS5043
License Number StateFL

VIII. Authorized Official

Name: MRS. REBEKAH PETTY
Title or Position: OWNER
Credential:
Phone: 352-746-1133