Provider Demographics
NPI:1033261847
Name:PERRYSBURG HEARING CENTER LLC
Entity Type:Organization
Organization Name:PERRYSBURG HEARING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JONES MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCCA
Authorized Official - Phone:419-873-1783
Mailing Address - Street 1:318 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1461
Mailing Address - Country:US
Mailing Address - Phone:419-873-1783
Mailing Address - Fax:419-873-0693
Practice Address - Street 1:318 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1461
Practice Address - Country:US
Practice Address - Phone:419-873-1783
Practice Address - Fax:419-873-0693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00661231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH300705152001OtherMEDICAL MUTUAL
OH000000330899OtherANTHEM BCBS
11570380OtherCAQH
OH2689434Medicaid
Q19741AUDIOLOGISTMedicare UPIN
OH2689434Medicaid