Provider Demographics
NPI:1134122997
Name:YARMOUTH AUDIOLOGY
Entity Type:Organization
Organization Name:YARMOUTH AUDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:MSC
Authorized Official - Phone:207-846-1380
Mailing Address - Street 1:163 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6720
Mailing Address - Country:US
Mailing Address - Phone:207-846-1380
Mailing Address - Fax:207-846-9701
Practice Address - Street 1:163 MAIN ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6720
Practice Address - Country:US
Practice Address - Phone:207-846-1380
Practice Address - Fax:207-846-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME51244237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME018055OtherANTHEM PROV #
MEMM0598Medicare ID - Type UnspecifiedMEDICARE PROV #