Provider Demographics
NPI:1639438708
Name:HANOVER AUDIOLOGY PLLC
Entity Type:Organization
Organization Name:HANOVER AUDIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:TINSLEY
Authorized Official - Last Name:HILES BRETT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:804-789-1754
Mailing Address - Street 1:7484 LEE DAVIS RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3678
Mailing Address - Country:US
Mailing Address - Phone:804-789-1764
Mailing Address - Fax:804-789-1762
Practice Address - Street 1:7484 LEE DAVIS RD
Practice Address - Street 2:SUITE 10
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3678
Practice Address - Country:US
Practice Address - Phone:804-789-1764
Practice Address - Fax:804-789-1762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201222629235Z00000X
VA2101001224237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty