Provider Demographics
NPI:1659612869
Name:AUDIOLOGY DISTRIBUTION, LLC
Entity Type:Organization
Organization Name:AUDIOLOGY DISTRIBUTION, LLC
Other - Org Name:HEARUSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:FERROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-478-8770
Mailing Address - Street 1:DEPT 3298
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60132-3298
Mailing Address - Country:US
Mailing Address - Phone:561-478-8770
Mailing Address - Fax:561-598-7231
Practice Address - Street 1:13460 N 94TH DR
Practice Address - Street 2:SUITE G-2
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4835
Practice Address - Country:US
Practice Address - Phone:623-933-0000
Practice Address - Fax:623-933-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ91797Medicare PIN