Healthcare Provider Details

I. General information

NPI: 1205996311
Provider Name (Legal Business Name): US AUDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 SHELBYVILLE RD
LOUISVILLE KY
40207-3203
US

IV. Provider business mailing address

4141SHELBYVILLE ROAD
LOUISVILLE KY
40207
US

V. Phone/Fax

Practice location:
  • Phone: 502-489-5022
  • Fax: 502-489-5066
Mailing address:
  • Phone: 502-489-5022
  • Fax: 502-489-5066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number273
License Number StateKY

VIII. Authorized Official

Name: KURT WEIDENBENNER
Title or Position: PRESIDENT
Credential:
Phone: 502-489-5022