Provider Demographics
NPI:1730487018
Name:RANDA MANSOUR SHOUSHER INC
Entity Type:Organization
Organization Name:RANDA MANSOUR SHOUSHER INC
Other - Org Name:NORTHWEST OHIO HEARING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDA
Authorized Official - Middle Name:MANSOUR
Authorized Official - Last Name:SHOUSHER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:419-383-4012
Mailing Address - Street 1:1125 HOSPITAL DR STE 50
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-8001
Mailing Address - Country:US
Mailing Address - Phone:419-383-4012
Mailing Address - Fax:419-383-6126
Practice Address - Street 1:1125 HOSPITAL DR STE 50
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-8001
Practice Address - Country:US
Practice Address - Phone:419-383-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0721928Medicaid
OH0722581Medicare UPIN