Provider Demographics
NPI:1003928763
Name:TAMPA SPEECH AND HEARING CENTER INC
Entity Type:Organization
Organization Name:TAMPA SPEECH AND HEARING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOHER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-A
Authorized Official - Phone:813-870-3560
Mailing Address - Street 1:4714 N ARMENIA AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2603
Mailing Address - Country:US
Mailing Address - Phone:813-870-3560
Mailing Address - Fax:813-870-0334
Practice Address - Street 1:4714 N ARMENIA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2603
Practice Address - Country:US
Practice Address - Phone:813-870-3560
Practice Address - Fax:813-870-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY193231H00000X
FLAY394231H00000X
FLAY832231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAY832OtherDIANA HOLLAND
FLAY832OtherDIANA HOLLAND
FLS0715ZMedicare ID - Type UnspecifiedHERBERT A. COX