Provider Demographics
NPI:1679143366
Name:CAPITAL INSTITUTE OF HEARING & BALANCE LLC
Entity Type:Organization
Organization Name:CAPITAL INSTITUTE OF HEARING & BALANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:CLARINE JACKSON
Authorized Official - Last Name:LOVITT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:240-670-1200
Mailing Address - Street 1:11886 HEALING WAY STE 530
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7917
Mailing Address - Country:US
Mailing Address - Phone:240-670-1200
Mailing Address - Fax:240-719-0534
Practice Address - Street 1:11886 HEALING WAY STE 530
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7917
Practice Address - Country:US
Practice Address - Phone:240-670-1200
Practice Address - Fax:240-719-0534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD547054400Medicaid