Provider Demographics
NPI:1508898107
Name:WILMINGTON AUDIOLOGY SERVIVCES
Entity Type:Organization
Organization Name:WILMINGTON AUDIOLOGY SERVIVCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEDFORD, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-654-1011
Mailing Address - Street 1:2300 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-1392
Mailing Address - Country:US
Mailing Address - Phone:302-654-1011
Mailing Address - Fax:
Practice Address - Street 1:2300 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 1-C
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1392
Practice Address - Country:US
Practice Address - Phone:302-654-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1989026866237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE127565OtherUNITED HEALTHCARE
DE2277668000OtherAMERIHEALTH HMO
DECJ8164OtherPALMETTO GBA
DE0000207702Medicaid
DE2277668000OtherAMERIHEALTH PPO
DE1598607OtherAMERIHEALTH ADMINISTRATOR
DE2277668000OtherINDEPENDENCE PERSONAL
DE0000207702OtherDIAMOND STATE PARTNERS
DE2277668000OtherKEYSTONE HEALTH PLAN EAST
DE55423OtherAETNA US HEALTHCARE
DE0000207702OtherDIAMOND STATE PARTNERS
DE2277668000OtherAMERIHEALTH PPO
DE55423OtherAETNA US HEALTHCARE
DE=========OtherMID-ATLANTIC HEALTH PLAN
DE2277668000OtherAMERIHEALTH HMO