Provider Demographics
NPI:1104366434
Name:CHAMPION HEARING AID CENTER LLC
Entity Type:Organization
Organization Name:CHAMPION HEARING AID CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GERHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:717-569-7450
Mailing Address - Street 1:2469C LITITZ PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3640
Mailing Address - Country:US
Mailing Address - Phone:717-569-7450
Mailing Address - Fax:717-569-7451
Practice Address - Street 1:2469C LITITZ PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-3640
Practice Address - Country:US
Practice Address - Phone:717-569-7450
Practice Address - Fax:717-569-7451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF02656237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty