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General NPI Number Information
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NPI Number | 1124193347
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Entity Type | Organization
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Legal Business Name | LOGAN AUDIOLOGY & HEARING AID CENTER INC
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 301 STRATTON STREET
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City | LOGAN
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State | WV
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Zip | 25601-3511
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Country | US
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Telephone | 304-752-6018
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Fax | 304-752-4805
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Provider Business Mailing Address
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Address Line | 301 STRATTON STREET
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City | LOGAN
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State | WV
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Zip | 25601-3511
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Country | US
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Telephone | 304-752-6018
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Fax | 304-752-4805
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. VERNON N MULLINS
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Credential | MA
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Telephone | 304-752-6018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | WVA005
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License Number State | WV
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