Healthcare Provider Details

I. General information

NPI: 1679933378
Provider Name (Legal Business Name): GILMORE AUDIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 LIBERTY ST
FRANKLIN PA
16323-1624
US

IV. Provider business mailing address

20737 BAIRD AVE
MEADVILLE PA
16335-8081
US

V. Phone/Fax

Practice location:
  • Phone: 814-432-2642
  • Fax: 814-437-2750
Mailing address:
  • Phone: 814-573-2212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAT001166L
License Number StatePA

VIII. Authorized Official

Name: DR. TERRI GILMORE
Title or Position: OWNER/AUDIOLOGIST
Credential: AU.D, CCC/A
Phone: 814-573-2212