Provider Demographics
NPI:1699812636
Name:MT. VERNON HEARING AID COMPANY
Entity Type:Organization
Organization Name:MT. VERNON HEARING AID COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING AID SPECIALISTS
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:PERRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-397-4055
Mailing Address - Street 1:150 RAMBLESIDE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2030
Mailing Address - Country:US
Mailing Address - Phone:419-756-0291
Mailing Address - Fax:
Practice Address - Street 1:20 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-3204
Practice Address - Country:US
Practice Address - Phone:740-397-4055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00967246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2651527Medicaid