Provider Demographics
NPI:1629168414
Name:ANDERSON AUDIOLOGY
Entity Type:Organization
Organization Name:ANDERSON AUDIOLOGY
Other - Org Name:HEARING AID SALES & SERVICE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:AUDIOLOGIST
Authorized Official - Phone:540-674-4889
Mailing Address - Street 1:85 CLEBURNE BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-4435
Mailing Address - Country:US
Mailing Address - Phone:540-674-4889
Mailing Address - Fax:540-674-1666
Practice Address - Street 1:85 CLEBURNE BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-4435
Practice Address - Country:US
Practice Address - Phone:540-674-4889
Practice Address - Fax:540-674-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000588237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009451447Medicaid
VA380784OtherANTHEM PROVIDER NUMBER
VA380784OtherANTHEM PROVIDER NUMBER