Healthcare Provider Details

I. General information

NPI: 1982925772
Provider Name (Legal Business Name): AUDIOLOGY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W SAINT CHARLES RD SUITE 4A
VILLA PARK IL
60181-2477
US

IV. Provider business mailing address

122 W SAINT CHARLES RD SUITE 4A
VILLA PARK IL
60181-2477
US

V. Phone/Fax

Practice location:
  • Phone: 800-459-7512
  • Fax: 800-459-7593
Mailing address:
  • Phone: 800-459-7512
  • Fax: 800-459-7593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: MR. SARGON KHAMO
Title or Position: PRESIDENT
Credential:
Phone: 800-459-7512