Provider Demographics
NPI:1437312212
Name:ATLANTIC HEARING CENTER INC
Entity Type:Organization
Organization Name:ATLANTIC HEARING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:401-942-8080
Mailing Address - Street 1:1150 RESERVOIR AVE
Mailing Address - Street 2:STE. 305B
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6068
Mailing Address - Country:US
Mailing Address - Phone:401-942-8080
Mailing Address - Fax:401-942-3666
Practice Address - Street 1:1150 RESERVOIR AVE
Practice Address - Street 2:STE. 305B
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6068
Practice Address - Country:US
Practice Address - Phone:401-942-8080
Practice Address - Fax:401-942-3666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAUD00042231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
709003966Medicare UPIN
007057334Medicare PIN