Provider Demographics
NPI:1053478578
Name:BELTONE HEARING AID SERVICE INC
Entity Type:Organization
Organization Name:BELTONE HEARING AID SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LASTRINA
Authorized Official - Suffix:
Authorized Official - Credentials:BS BHIS ACA
Authorized Official - Phone:860-635-4886
Mailing Address - Street 1:769 NEWFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1846
Mailing Address - Country:US
Mailing Address - Phone:860-635-4886
Mailing Address - Fax:860-635-7087
Practice Address - Street 1:769 NEWFIELD ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-1846
Practice Address - Country:US
Practice Address - Phone:860-635-4886
Practice Address - Fax:860-635-7087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT134332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004156453Medicaid