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General NPI Number Information
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NPI Number | 1619336815
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Entity Type | Organization
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Legal Business Name | TRI STATE HEARING CARE CENTER LLC
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 02/16/2016
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Provider Practice Location Address
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Address Line | 1911 S MAIN ST
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City | CORBIN
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State | KY
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Zip | 40701-2031
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Country | US
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Telephone | 606-528-1101
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Fax | 606-528-9825
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Provider Business Mailing Address
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Address Line | 1911 S MAIN ST
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City | CORBIN
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State | KY
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Zip | 40701-2031
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Country | US
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Telephone | 606-528-1101
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Fax | 606-528-9825
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | ROB D MOORE
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Credential | OWNER/SPECIALIST
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Telephone | 606-528-1101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 1032
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License Number State | KY
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