Healthcare Provider Details

I. General information

NPI: 1184035131
Provider Name (Legal Business Name): BEULAH'S HEARING AID CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 EURY LN SUITE 5
SOMERSET KY
42501-4115
US

IV. Provider business mailing address

23 EURY LN SUITE 5
SOMERSET KY
42501-4115
US

V. Phone/Fax

Practice location:
  • Phone: 606-676-0013
  • Fax: 606-676-0058
Mailing address:
  • Phone: 606-676-0013
  • Fax: 606-676-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0887
License Number StateKY

VIII. Authorized Official

Name: MS. BEULAH N. JACKSON
Title or Position: OWNER/HEARING INSTRUMENT SPECIALIST
Credential: HEARING INSTRUMENT S
Phone: 606-676-0013