Healthcare Provider Details

I. General information

NPI: 1598981524
Provider Name (Legal Business Name): PRINCETON AUDIOLOGY CLINIC, INC.,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 STADIUM DRIVE SUITE D
BLUEFIELD WV
24701
US

IV. Provider business mailing address

508 NEW HOPE ROAD SUITE #19
PRINCETON WV
24740-2272
US

V. Phone/Fax

Practice location:
  • Phone: 304-324-2954
  • Fax: 304-324-2955
Mailing address:
  • Phone: 304-487-2487
  • Fax: 304-431-3367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: ALAN L. DESMOND
Title or Position: PRESIDENT
Credential: AU.D., CCC-A
Phone: 304-487-2487