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NPI Code Detail

MEDICARE: MIAMI VALLEY HEARING AND BALANCE, LLC

MEDICARE: MIAMI VALLEY HEARING AND BALANCE, 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
1174400000XSpecialistA-1009OH

General Provider Information

NPI Number : 1295106516
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIAMI VALLEY HEARING AND BALANCE, LLC
Provider Business Mailing Address
First Line : 4720 WILMINGTON PIKE
Second Line :
City : KETTERING
State : OH
Zip : 45440-2021
Country : US
Telephone Number : 937-435-5033
Fax Number : 937-435-5512
Provider Business Practice Location Address
First Line : 4720 WILMINGTON PIKE
Second Line :
City : KETTERING
State : OH
Zip : 45440-2021
Country : US
Telephone Number : 937-435-5033
Fax Number : 937-435-5512
Authorized Official
Title or Position : SOLE BUSINESS OWNER
Name : LYNN CARPENTER
Credential : AUD
Telephone Number : 937-435-5033
Provider Enumeration Date : 10/13/2015
Last Update Date : 10/13/2015

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