Healthcare Provider Details

I. General information

NPI: 1609444355
Provider Name (Legal Business Name): TED ALVIN LAUGHLIN H.I.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8780 US HWY #42 SUITE D
FLORENCE KY
41042
US

IV. Provider business mailing address

8780 US HWY #42 SUITE D
FLORENCE KY
41042
US

V. Phone/Fax

Practice location:
  • Phone: 859-384-0333
  • Fax: 859-384-1333
Mailing address:
  • Phone: 859-384-0333
  • Fax: 859-384-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number241988
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: