Provider Demographics
NPI:1437299161
Name:HETSKO AUDIOLOGY, INC.
Entity Type:Organization
Organization Name:HETSKO AUDIOLOGY, INC.
Other - Org Name:OBERLIN HEARING CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HETSKO
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:440-774-5819
Mailing Address - Street 1:224 W LORAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:OBERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44074-1096
Mailing Address - Country:US
Mailing Address - Phone:440-775-1083
Mailing Address - Fax:440-774-5920
Practice Address - Street 1:224 W LORAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1096
Practice Address - Country:US
Practice Address - Phone:440-775-1083
Practice Address - Fax:440-774-5920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02598237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS28814Medicare UPIN
OHHE0419454Medicare ID - Type UnspecifiedINDIVIDUAL
OH2245903Medicare ID - Type UnspecifiedFACILITY
OHHE9314661Medicare ID - Type UnspecifiedGROUP