Healthcare Provider Details

I. General information

NPI: 1821226267
Provider Name (Legal Business Name): TLC HEARING CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6704 OLD TRAIL RD
FORT WAYNE IN
46809-2639
US

IV. Provider business mailing address

6704 OLD TRAIL RD
FORT WAYNE IN
46809-2639
US

V. Phone/Fax

Practice location:
  • Phone: 260-747-0135
  • Fax:
Mailing address:
  • Phone: 260-747-0135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17000598A
License Number StateIN

VIII. Authorized Official

Name: MR. EUGENE F ALLES
Title or Position: CO-OWNER / TREASURER
Credential: HIS
Phone: 260-747-0135