Provider Demographics
NPI:1639183585
Name:ROBERT MOORE HEARING AID CENTER, DBA BELTONE
Entity Type:Organization
Organization Name:ROBERT MOORE HEARING AID CENTER, DBA BELTONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEULAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-679-1965
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42502-0048
Mailing Address - Country:US
Mailing Address - Phone:606-679-1965
Mailing Address - Fax:606-678-8465
Practice Address - Street 1:409 OGDEN ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-1723
Practice Address - Country:US
Practice Address - Phone:606-679-1965
Practice Address - Fax:606-678-8465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0242231H00000X
TN1142237600000X
KY621237700000X
TN589237700000X
VA2101237700000X
KY188237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000048001OtherBCBS
KY000000070194OtherBCBS