Provider Demographics
NPI:1376951848
Name:HBC AUDIOLOGY HEARING CARE SERVICE LLC
Entity Type:Organization
Organization Name:HBC AUDIOLOGY HEARING CARE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:304-264-8884
Mailing Address - Street 1:1881 HARVEST DR
Mailing Address - Street 2:WILLOWS AT MEADOW BRANCH
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6350
Mailing Address - Country:US
Mailing Address - Phone:304-264-8884
Mailing Address - Fax:888-720-0545
Practice Address - Street 1:1881 HARVEST DR
Practice Address - Street 2:WILLOWS AT MEADOW BRANCH
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6350
Practice Address - Country:US
Practice Address - Phone:304-264-8884
Practice Address - Fax:888-720-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA0095237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVQ42430AMedicare UPIN