Healthcare Provider Details

I. General information

NPI: 1710239967
Provider Name (Legal Business Name): PROFESSIONAL AUDIOLOGICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5118 STAGE RD
MEMPHIS TN
38134-3166
US

IV. Provider business mailing address

5108 STAGE RD
MEMPHIS TN
38134-3164
US

V. Phone/Fax

Practice location:
  • Phone: 901-372-0040
  • Fax: 901-372-8685
Mailing address:
  • Phone: 901-372-0040
  • Fax: 901-372-8685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberA103
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberA103
License Number StateTN

VIII. Authorized Official

Name: LORETTA COLTHARP MORTON
Title or Position: PRESIDENT
Credential: AU.D.
Phone: 901-372-0040