Provider Demographics
NPI:1124409651
Name:BALANCE AND EAR CENTER
Entity Type:Organization
Organization Name:BALANCE AND EAR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:EDDOWES
Authorized Official - Suffix:
Authorized Official - Credentials:COPM
Authorized Official - Phone:804-288-3277
Mailing Address - Street 1:10200 THREE CHOPT RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-2083
Mailing Address - Country:US
Mailing Address - Phone:804-288-3277
Mailing Address - Fax:804-282-1043
Practice Address - Street 1:10200 THREE CHOPT RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-2083
Practice Address - Country:US
Practice Address - Phone:804-288-3277
Practice Address - Fax:804-282-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2102002786231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty