Provider Demographics
NPI:1275779555
Name:PROFESSIONAL HEARING AID CTR
Entity Type:Organization
Organization Name:PROFESSIONAL HEARING AID CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DISPENSER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:CAECILIA
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-638-4158
Mailing Address - Street 1:705 PROFESSIONAL PLAZA
Mailing Address - Street 2:#3
Mailing Address - City:GREENVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745
Mailing Address - Country:US
Mailing Address - Phone:423-638-4158
Mailing Address - Fax:423-638-4158
Practice Address - Street 1:705 PROFESSIONAL PLAZA
Practice Address - Street 2:#3
Practice Address - City:GREENVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745
Practice Address - Country:US
Practice Address - Phone:423-638-4158
Practice Address - Fax:423-638-4158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000515332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment