Provider Demographics
NPI:1619003332
Name:MODERN HEARING AID CENTER INC.
Entity Type:Organization
Organization Name:MODERN HEARING AID CENTER INC.
Other - Org Name:EAST ALABAMA HEARING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOSARGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-362-0037
Mailing Address - Street 1:115 COURT ST N
Mailing Address - Street 2:SUITE B
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2013
Mailing Address - Country:US
Mailing Address - Phone:256-362-0037
Mailing Address - Fax:256-362-0911
Practice Address - Street 1:115 COURT ST N
Practice Address - Street 2:SUITE B
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2013
Practice Address - Country:US
Practice Address - Phone:256-362-0037
Practice Address - Fax:256-362-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0284A231H00000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Not Answered332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP67310Medicare UPIN