Provider Demographics
NPI:1336475433
Name:AUDIO HEARING AID CENTER OF CENTRALIA
Entity Type:Organization
Organization Name:AUDIO HEARING AID CENTER OF CENTRALIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HEARING AID SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-532-8452
Mailing Address - Street 1:416 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3513
Mailing Address - Country:US
Mailing Address - Phone:618-532-8452
Mailing Address - Fax:618-532-5611
Practice Address - Street 1:416 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3513
Practice Address - Country:US
Practice Address - Phone:618-532-8452
Practice Address - Fax:618-532-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1386332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment