Provider Demographics
NPI:1073795944
Name:SOUTHEAST KENTUCKY AUDIOLOGY SERVICES INC.
Entity Type:Organization
Organization Name:SOUTHEAST KENTUCKY AUDIOLOGY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-528-9993
Mailing Address - Street 1:200 ALLISON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-7964
Mailing Address - Country:US
Mailing Address - Phone:606-528-9993
Mailing Address - Fax:606-528-5553
Practice Address - Street 1:200 ALLISON BLVD
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-7964
Practice Address - Country:US
Practice Address - Phone:606-528-9993
Practice Address - Fax:606-528-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Y00000X, 231H00000X, 235Z00000X, 237700000X, 252Y00000X, 261QM1300X, 332S00000X
KY00380261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30954OtherBLUEGRASS FAMILY HEALTH
C66002OtherCHI
KY000000294056OtherANTHEM BC/BS
KY1205224OtherCHA
KY70001037Medicaid
KY70001037Medicaid
KYP89536Medicare UPIN