Provider Demographics
NPI:1710969928
Name:PROFESSIONAL HEARING CARE INC
Entity Type:Organization
Organization Name:PROFESSIONAL HEARING CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALENTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHNIVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MAT
Authorized Official - Phone:765-664-3470
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-0106
Mailing Address - Country:US
Mailing Address - Phone:765-664-3470
Mailing Address - Fax:765-664-3489
Practice Address - Street 1:915 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2505
Practice Address - Country:US
Practice Address - Phone:765-664-3470
Practice Address - Fax:765-664-3489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100417580AMedicaid
000000188598OtherBLUE CROSS - AUDIOLOGY
000000209060OtherBLUE CROSS - HEARING AIDS
IN100417580AMedicaid