Provider Demographics
NPI:1114105616
Name:COLONIAL CENTER FOR HEARING INC
Entity Type:Organization
Organization Name:COLONIAL CENTER FOR HEARING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPTAKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-229-4004
Mailing Address - Street 1:430 MCLAWS CIR
Mailing Address - Street 2:STE 101
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5655
Mailing Address - Country:US
Mailing Address - Phone:757-229-4004
Mailing Address - Fax:757-229-9992
Practice Address - Street 1:430 MCLAWS CIR
Practice Address - Street 2:STE 101
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5655
Practice Address - Country:US
Practice Address - Phone:757-229-4004
Practice Address - Fax:757-229-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA169589OtherANTHEM
C10439Medicare PIN