Provider Demographics
NPI:1508912924
Name:CHAC INC
Entity Type:Organization
Organization Name:CHAC INC
Other - Org Name:PROFESSIONAL HEARING AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:850-438-4092
Mailing Address - Street 1:115 N PALAFOX ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-4838
Mailing Address - Country:US
Mailing Address - Phone:850-438-4092
Mailing Address - Fax:850-438-4095
Practice Address - Street 1:115 N PALAFOX ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-4838
Practice Address - Country:US
Practice Address - Phone:850-438-4092
Practice Address - Fax:850-438-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1294231H00000X, 235500000X, 237600000X, 332S00000X
FLAS 1379235500000X, 237700000X, 332B00000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332S00000XSuppliersHearing Aid Equipment
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT-0094OtherBCBS
FL085155800Medicaid
FL161297600OtherACS PROVIDER NUMBER
FL085429800Medicaid
FL085155802Medicaid
FLJ-0195OtherUAW