Healthcare Provider Details

I. General information

NPI: 1124537766
Provider Name (Legal Business Name): MOBILE AUDIOLOGY OF WEST VIRGINIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 WASHINGTON ST W
CHARLESTON WV
25302-2348
US

IV. Provider business mailing address

1200 KIRTS BLVD STE 200
TROY MI
48084-4899
US

V. Phone/Fax

Practice location:
  • Phone: 248-528-1981
  • Fax: 614-416-2105
Mailing address:
  • Phone: 248-528-1981
  • Fax: 614-416-2105

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: SCOTT J GIAIMO
Title or Position: OWNER
Credential: DPM
Phone: 248-528-1981