Provider Demographics
NPI:1124537766
Name:MOBILE AUDIOLOGY OF WEST VIRGINIA PLLC
Entity Type:Organization
Organization Name:MOBILE AUDIOLOGY OF WEST VIRGINIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIAIMO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-528-1981
Mailing Address - Street 1:1200 KIRTS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4899
Mailing Address - Country:US
Mailing Address - Phone:248-528-1981
Mailing Address - Fax:614-416-2105
Practice Address - Street 1:209 WASHINGTON ST W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2348
Practice Address - Country:US
Practice Address - Phone:248-528-1981
Practice Address - Fax:614-416-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000OtherN/A