Provider Demographics
NPI:1639472715
Name:AUDIOLOGY ASSOCIATES OF HAMMOND LLC
Entity Type:Organization
Organization Name:AUDIOLOGY ASSOCIATES OF HAMMOND LLC
Other - Org Name:AUDIOLOGY ASSOCIATES OF HAMMOND
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING/CREDENTIALING MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-542-2521
Mailing Address - Street 1:15706 PROFESSIONAL PLZ
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1451
Mailing Address - Country:US
Mailing Address - Phone:985-542-2521
Mailing Address - Fax:985-542-0474
Practice Address - Street 1:15706 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1451
Practice Address - Country:US
Practice Address - Phone:985-542-2521
Practice Address - Fax:985-542-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP51630Medicare PIN