Provider Demographics
NPI:1467641167
Name:BROADWATER HEARING CARE INC
Entity Type:Organization
Organization Name:BROADWATER HEARING CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:727-323-2471
Mailing Address - Street 1:4107 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-6303
Mailing Address - Country:US
Mailing Address - Phone:727-323-2471
Mailing Address - Fax:727-323-3577
Practice Address - Street 1:4107 5TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-6303
Practice Address - Country:US
Practice Address - Phone:727-323-2471
Practice Address - Fax:727-323-3577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech