Provider Demographics
NPI:1609316215
Name:AFFORDABLE DIGITAL HEARING
Entity Type:Organization
Organization Name:AFFORDABLE DIGITAL HEARING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:812-234-9332
Mailing Address - Street 1:37 MEADOWS SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-2373
Mailing Address - Country:US
Mailing Address - Phone:812-234-9332
Mailing Address - Fax:
Practice Address - Street 1:37 MEADOWS SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-2373
Practice Address - Country:US
Practice Address - Phone:812-234-9332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001164A251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare