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General NPI Number Information
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NPI Number | 1710239967
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL AUDIOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 10/12/2012
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 5118 STAGE RD
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City | MEMPHIS
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State | TN
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Zip | 38134-3166
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Country | US
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Telephone | 901-372-0040
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Fax | 901-372-8685
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Provider Business Mailing Address
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Address Line | 5108 STAGE RD
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City | MEMPHIS
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State | TN
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Zip | 38134-3164
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Country | US
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Telephone | 901-372-0040
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Fax | 901-372-8685
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Authorized Official
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Title or Position | PRESIDENT
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Name | LORETTA COLTHARP MORTON
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Credential | AU.D.
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Telephone | 901-372-0040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | A103
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 231HA2500X
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Taxonomy Name | Assistive Technology Supplier Audiologist
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License Number | A103
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License Number State | TN
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