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General NPI Number Information
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NPI Number | 1912441551
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Entity Type | Organization
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Legal Business Name | TRICOUNTY PREMIER HEARING SERVICES INC
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 1004 N 14TH ST
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City | LEESBURG
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State | FL
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Zip | 34748-3850
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Country | US
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Telephone | 352-561-3180
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Fax |
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Provider Business Mailing Address
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Address Line | 707 OAKS SHORES RD
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City | LEESBURG
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State | FL
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Zip | 34748-7153
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Country | US
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Telephone | 352-365-1593
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DIVYA KHIRBAT
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Credential |
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Telephone | 352-561-3180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | AS5250
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License Number State | FL
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