MEDICARE: COUNTRY ROADS AUDIOLOGY AND HEARING AID CENTER, 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	231H00000X	Audiologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1003904392	OTHER		NPI

General Provider Information

NPI Number	:	1992363261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTRY ROADS AUDIOLOGY AND HEARING AID CENTER, LLC

Provider Business Mailing Address
First Line	:	1741 VIRGINIA AVE STE C
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22802-8330
Country	:	US
Telephone Number	:	540-209-8993
Fax Number	:	540-217-2346

Provider Business Practice Location Address
First Line	:	1741 VIRGINIA AVE STE C
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22802-8330
Country	:	US
Telephone Number	:	540-209-8993
Fax Number	:	540-217-2346

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTIN QUESENBERRY
Credential	:
Telephone Number	:	540-282-7727

Provider Enumeration Date	:	06/03/2019
Last Update Date	:	06/03/2019

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