Provider Demographics
NPI:1124565940
Name:COUNTRYSIDE HEARING AID SERVICES, INC
Entity Type:Organization
Organization Name:COUNTRYSIDE HEARING AID SERVICES, INC
Other - Org Name:MITCHELL HEARING CONSULTANTS, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-796-1161
Mailing Address - Street 1:25829 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-2034
Mailing Address - Country:US
Mailing Address - Phone:727-796-1161
Mailing Address - Fax:727-796-1249
Practice Address - Street 1:25829 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-2034
Practice Address - Country:US
Practice Address - Phone:727-796-1161
Practice Address - Fax:727-796-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS3091237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty