Provider Demographics
NPI:1659868925
Name:IMPERIAL HEARING, LLC
Entity Type:Organization
Organization Name:IMPERIAL HEARING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:HOLL
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:205-532-1008
Mailing Address - Street 1:3780 PETERS CREEK ROAD EXT SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-1528
Mailing Address - Country:US
Mailing Address - Phone:205-532-1008
Mailing Address - Fax:
Practice Address - Street 1:3780 PETERS CREEK ROAD EXT SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1528
Practice Address - Country:US
Practice Address - Phone:205-532-1008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-22
Last Update Date:2018-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech