Healthcare Provider Details

I. General information

NPI: 1396250007
Provider Name (Legal Business Name): MADISON COUNTY HEARING AID CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 S MAIN ST
LONDON OH
43140-1243
US

IV. Provider business mailing address

3 S MAIN ST
LONDON OH
43140-1243
US

V. Phone/Fax

Practice location:
  • Phone: 740-852-7843
  • Fax: 740-490-7601
Mailing address:
  • Phone: 740-852-7843
  • Fax: 740-490-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number02325
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number02325
License Number StateOH

VIII. Authorized Official

Name: REBECCA BRENISER
Title or Position: OWNER/DISPENSER
Credential:
Phone: 740-981-7597