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General NPI Number Information
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NPI Number | 1700130317
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Entity Type | Organization
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Legal Business Name | SAM'S CLUB HEARING CENTER #6365
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 970 HILTON HEIGHTS RD
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-8393
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Country | US
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Telephone | 434-978-1205
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Fax |
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Provider Business Mailing Address
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Address Line | 970 HILTON HEIGHTS RD
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-8393
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Country | US
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Telephone | 434-978-1205
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Fax |
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Authorized Official
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Title or Position | HEARING AID SPECIALIST
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Name | MS. FREDA SUE WHITE
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Credential |
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Telephone | 434-978-1205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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