Healthcare Provider Details

I. General information

NPI: 1922554344
Provider Name (Legal Business Name): EVANSVILLE HEARING AID CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 E DIAMOND AVE
EVANSVILLE IN
47711-3716
US

IV. Provider business mailing address

580 E DIAMOND AVE
EVANSVILLE IN
47711-3716
US

V. Phone/Fax

Practice location:
  • Phone: 812-424-5116
  • Fax:
Mailing address:
  • Phone: 812-424-5116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA RENEE BENNETT
Title or Position: OWNER/HAD
Credential: HAD
Phone: 812-424-5116