Provider Demographics
NPI:1760669725
Name:HEARING CENTER OF SOUTHAMPTON, PC
Entity Type:Organization
Organization Name:HEARING CENTER OF SOUTHAMPTON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST; AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM; MCAA
Authorized Official - Phone:215-953-0513
Mailing Address - Street 1:545 STREET RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3786
Mailing Address - Country:US
Mailing Address - Phone:215-953-0513
Mailing Address - Fax:215-953-0516
Practice Address - Street 1:545 STREET RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3786
Practice Address - Country:US
Practice Address - Phone:215-953-0513
Practice Address - Fax:215-953-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003337L332B00000X, 335E00000X
PAAT000591L332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332S00000XSuppliersHearing Aid Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5801400001Medicare NSC