Provider Demographics
NPI:1740398460
Name:NORTHEAST ALABAMA AUDIOLOGY CLINIC
Entity Type:Organization
Organization Name:NORTHEAST ALABAMA AUDIOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-543-9302
Mailing Address - Street 1:PO BOX 1399
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-1399
Mailing Address - Country:US
Mailing Address - Phone:256-543-8899
Mailing Address - Fax:256-543-8002
Practice Address - Street 1:313 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5212
Practice Address - Country:US
Practice Address - Phone:256-543-8899
Practice Address - Fax:256-543-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D955Medicare ID - Type Unspecified