Provider Demographics
NPI:1760497101
Name:WAGNER HEARING AID SERVICE INC
Entity Type:Organization
Organization Name:WAGNER HEARING AID SERVICE INC
Other - Org Name:WAGNER HEARING AID CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-AUDIOLOGY
Authorized Official - Phone:434-293-7368
Mailing Address - Street 1:218 W MARKET ST
Mailing Address - Street 2:STE 7
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5061
Mailing Address - Country:US
Mailing Address - Phone:434-293-7368
Mailing Address - Fax:434-293-5752
Practice Address - Street 1:218 W MARKET ST
Practice Address - Street 2:STE 7
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5061
Practice Address - Country:US
Practice Address - Phone:434-293-7368
Practice Address - Fax:434-293-5752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000223237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9105531Medicaid