Provider Demographics
NPI:1760555874
Name:PROFESSIONAL HEARING AID SERVICE, INC
Entity Type:Organization
Organization Name:PROFESSIONAL HEARING AID SERVICE, INC
Other - Org Name:AUDIBEL HEARING AID CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:HEARING AID SPEC
Authorized Official - Phone:804-796-3210
Mailing Address - Street 1:11923 CENTRE ST
Mailing Address - Street 2:SUITE A3
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1702
Mailing Address - Country:US
Mailing Address - Phone:804-796-3210
Mailing Address - Fax:804-796-1112
Practice Address - Street 1:11923 CENTRE ST
Practice Address - Street 2:SUITE A3
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1702
Practice Address - Country:US
Practice Address - Phone:804-796-3210
Practice Address - Fax:804-796-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101-000328332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA91-05794Medicaid