Provider Demographics
NPI:1619336815
Name:TRI STATE HEARING CARE CENTER LLC
Entity Type:Organization
Organization Name:TRI STATE HEARING CARE CENTER LLC
Other - Org Name:BELTONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER/SPECIALIST
Authorized Official - Phone:606-528-1101
Mailing Address - Street 1:1911 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2031
Mailing Address - Country:US
Mailing Address - Phone:606-528-1101
Mailing Address - Fax:606-528-9825
Practice Address - Street 1:1911 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2031
Practice Address - Country:US
Practice Address - Phone:606-528-1101
Practice Address - Fax:606-528-9825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1032332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment