Provider Demographics
NPI:1629369228
Name:JERRY & CAROLYN DESPAIN HEARING AID CENTER, LLC
Entity Type:Organization
Organization Name:JERRY & CAROLYN DESPAIN HEARING AID CENTER, LLC
Other - Org Name:BELTONE HEARING AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:NO MIDDLE NAME
Authorized Official - Last Name:DESPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:NBC/HIS
Authorized Official - Phone:270-926-6822
Mailing Address - Street 1:2309 FREDERICA ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-4827
Mailing Address - Country:US
Mailing Address - Phone:270-926-6822
Mailing Address - Fax:270-683-1733
Practice Address - Street 1:2309 FREDERICA ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4827
Practice Address - Country:US
Practice Address - Phone:270-926-6822
Practice Address - Fax:270-683-1733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY357237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty