Provider Demographics
NPI:1548383334
Name:EAR NOSE AND THROAT ASSOCIATES OF CLARKSBURG INC
Entity Type:Organization
Organization Name:EAR NOSE AND THROAT ASSOCIATES OF CLARKSBURG INC
Other - Org Name:CLARKSBURG AUDIOLOGY AND HEARING AID CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-622-4397
Mailing Address - Street 1:125 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2665
Mailing Address - Country:US
Mailing Address - Phone:304-622-4397
Mailing Address - Fax:304-623-4823
Practice Address - Street 1:125 N 6TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2665
Practice Address - Country:US
Practice Address - Phone:304-622-4397
Practice Address - Fax:304-623-4823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA0032237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3402009000Medicaid