Healthcare Provider Details

I. General information

NPI: 1386185254
Provider Name (Legal Business Name): EDGAR HILL AUDIOPROSTHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W. LEXINGTON AVE.
WINCHESTER KY
40391
US

IV. Provider business mailing address

1515 W LEXINGTON AVE
WINCHESTER KY
40391-3106
US

V. Phone/Fax

Practice location:
  • Phone: 859-737-9727
  • Fax: 859-737-0146
Mailing address:
  • Phone: 859-737-9727
  • Fax: 859-737-0146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number100478
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: