Provider Demographics
NPI:1396867768
Name:SOUTHERN HEARING AID, INC.
Entity Type:Organization
Organization Name:SOUTHERN HEARING AID, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING INSTRUMENT SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GRAYDON
Authorized Official - Middle Name:B
Authorized Official - Last Name:CUMMINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:LHIS
Authorized Official - Phone:606-678-4010
Mailing Address - Street 1:370 S HIGHWAY 27 STE 5
Mailing Address - Street 2:TRADEWIND SHOPPING CENTER
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-2774
Mailing Address - Country:US
Mailing Address - Phone:606-678-4010
Mailing Address - Fax:
Practice Address - Street 1:370 S HIGHWAY 27 STE 5
Practice Address - Street 2:TRADEWIND SHOPPING CENTER
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2774
Practice Address - Country:US
Practice Address - Phone:606-678-4010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000070472OtherANTHEM BCBS MEMBER #