Provider Demographics
NPI:1326227679
Name:APPALACHIAN HEARING AND BALANCE
Entity Type:Organization
Organization Name:APPALACHIAN HEARING AND BALANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS,FFFA
Authorized Official - Phone:276-326-3890
Mailing Address - Street 1:1242 HOCKMAN PIKE
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-9351
Mailing Address - Country:US
Mailing Address - Phone:276-326-3890
Mailing Address - Fax:276-322-1514
Practice Address - Street 1:1242 HOCKMAN PIKE
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-9351
Practice Address - Country:US
Practice Address - Phone:276-326-3890
Practice Address - Fax:276-322-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000378,220100126231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty