Healthcare Provider Details

I. General information

NPI: 1710969928
Provider Name (Legal Business Name): PROFESSIONAL HEARING CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N WESTERN AVE
MARION IN
46952-2505
US

IV. Provider business mailing address

PO BOX 106
MARION IN
46952-0106
US

V. Phone/Fax

Practice location:
  • Phone: 765-664-3470
  • Fax: 765-664-3489
Mailing address:
  • Phone: 765-664-3470
  • Fax: 765-664-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: MRS. VALENTINA BACHNIVSKY
Title or Position: PRESIDENT
Credential: MAT
Phone: 765-664-3470