Provider Demographics
NPI:1699842898
Name:AUDIOLOGY MANAGEMENT SERVICES LLC
Entity Type:Organization
Organization Name:AUDIOLOGY MANAGEMENT SERVICES LLC
Other - Org Name:CROSSVILLE HEARING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FS
Authorized Official - Middle Name:BRONN
Authorized Official - Last Name:RAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-526-8863
Mailing Address - Street 1:100 W 4TH ST
Mailing Address - Street 2:STE 320
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2448
Mailing Address - Country:US
Mailing Address - Phone:931-526-8863
Mailing Address - Fax:931-525-3559
Practice Address - Street 1:1700 WEST AVE
Practice Address - Street 2:STE 102
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-6090
Practice Address - Country:US
Practice Address - Phone:931-456-2952
Practice Address - Fax:931-707-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370313Medicare PIN