Healthcare Provider Details

I. General information

NPI: 1316611700
Provider Name (Legal Business Name): MADISON HEARING HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 CLIFTY DR
MADISON IN
47250-1608
US

IV. Provider business mailing address

529 CLIFTY DR
MADISON IN
47250-1608
US

V. Phone/Fax

Practice location:
  • Phone: 812-273-6262
  • Fax: 812-273-1915
Mailing address:
  • Phone: 812-273-6262
  • Fax: 812-273-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN L HENDRICKS
Title or Position: AUDIOLOGIST, BUSINESS OWNER
Credential: AU.D.
Phone: 812-273-6262