Provider Demographics
NPI:1477809614
Name:MURFREESBORO AUDIOLOGY CLINIC
Entity Type:Organization
Organization Name:MURFREESBORO AUDIOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:STOCKDELL
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:615-890-3686
Mailing Address - Street 1:811 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-4927
Mailing Address - Country:US
Mailing Address - Phone:615-890-3686
Mailing Address - Fax:615-890-0688
Practice Address - Street 1:811 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-4927
Practice Address - Country:US
Practice Address - Phone:615-890-3686
Practice Address - Fax:615-890-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN75261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4043611OtherBLUE CROSS BLUE SHIELD OF TENNESSEE