Provider Demographics
NPI:1497932768
Name:SENIOR AUDIOLOGY,LLC
Entity Type:Organization
Organization Name:SENIOR AUDIOLOGY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ARDEN
Authorized Official - Last Name:ORRAHOOD
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:304-842-9229
Mailing Address - Street 1:132 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1715
Mailing Address - Country:US
Mailing Address - Phone:304-842-9229
Mailing Address - Fax:
Practice Address - Street 1:132 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1715
Practice Address - Country:US
Practice Address - Phone:304-842-9229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVR77480Medicare UPIN