Healthcare Provider Details

I. General information

NPI: 1528391844
Provider Name (Legal Business Name): CHARLEY J CASH HAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3526 OSBORNE LN STE D
LAFAYETTE IN
47909-3998
US

IV. Provider business mailing address

3526 OSBORNE LN STE D
LAFAYETTE IN
47909-3998
US

V. Phone/Fax

Practice location:
  • Phone: 765-471-2111
  • Fax: 765-471-2112
Mailing address:
  • Phone: 765-471-2111
  • Fax: 765-471-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001329A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: