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General NPI Number Information
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NPI Number | 1720629264
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Entity Type | Organization
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Legal Business Name | KOCH HEARING LLC
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 2297 SEMINOLE LN
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-8300
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Country | US
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Telephone | 919-995-3823
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Fax | 434-299-8892
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Provider Business Mailing Address
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Address Line | 25 KENSINGTON DR
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City | YOUNGSVILLE
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State | NC
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Zip | 27596-7624
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Country | US
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Telephone | 919-995-3823
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Fax | 434-299-8892
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Authorized Official
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Title or Position | BUSINESS DIRECTOR
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Name | MR. ANTHONY R THACHER
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Credential |
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Telephone | 919-995-3823
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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 |
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License Number State |
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