Healthcare Provider Details

I. General information

NPI: 1659868925
Provider Name (Legal Business Name): IMPERIAL HEARING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2018
Last Update Date: 04/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3780 PETERS CREEK ROAD EXT SW
ROANOKE VA
24018-1528
US

IV. Provider business mailing address

3780 PETERS CREEK ROAD EXT SW
ROANOKE VA
24018-1528
US

V. Phone/Fax

Practice location:
  • Phone: 205-532-1008
  • Fax:
Mailing address:
  • Phone: 205-532-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GENEVIEVE HOLL HARRIS
Title or Position: CLINICAL DIRECTOR
Credential: AU.D.
Phone: 205-532-1008