Healthcare Provider Details

I. General information

NPI: 1720629264
Provider Name (Legal Business Name): KOCH HEARING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2297 SEMINOLE LN
CHARLOTTESVILLE VA
22901-8300
US

IV. Provider business mailing address

25 KENSINGTON DR
YOUNGSVILLE NC
27596-7624
US

V. Phone/Fax

Practice location:
  • Phone: 919-995-3823
  • Fax: 434-299-8892
Mailing address:
  • Phone: 919-995-3823
  • Fax: 434-299-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY R THACHER
Title or Position: BUSINESS DIRECTOR
Credential:
Phone: 919-995-3823