Healthcare Provider Details

I. General information

NPI: 1467147058
Provider Name (Legal Business Name): KEY HEARING AIDS OF FORT WAYNE SOUTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4916 ILLINOIS RD STE 105
FORT WAYNE IN
46804-5116
US

IV. Provider business mailing address

40 EXECUTIVE DR STE F
CARMEL IN
46032-5479
US

V. Phone/Fax

Practice location:
  • Phone: 260-408-5327
  • Fax: 260-408-7408
Mailing address:
  • Phone: 317-689-7171
  • Fax: 317-451-4810

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: GANESH KRIPAPURI
Title or Position: MANAGER
Credential:
Phone: 831-277-2694