MEDICARE: AUDIOLOGY SERVICES COMPANY USA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1104673409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDIOLOGY SERVICES COMPANY USA, LLC

Provider Business Mailing Address
First Line	:	2501 COTTONTAIL LN
Second Line	:
City	:	SOMERSET
State	:	NJ
Zip	:	08873-5125
Country	:	US
Telephone Number	:	732-529-7120
Fax Number	:

Provider Business Practice Location Address
First Line	:	2642 W HORIZON RIDGE PKWY STE A11
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-2873
Country	:	US
Telephone Number	:	702-933-9102
Fax Number	:

Authorized Official
Title or Position	:	VP, REV CYCLE AND PAYER RELATIONS
Name	:	BAHAR BAZMI
Credential	:
Telephone Number	:	412-260-1504

Provider Enumeration Date	:	05/03/2024
Last Update Date	:	05/03/2024

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