Provider Demographics
NPI:1760699839
Name:KEVIN T. BARLOW, PA
Entity Type:Organization
Organization Name:KEVIN T. BARLOW, PA
Other - Org Name:WINTER HAVEN AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CLINICIAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, FAAA
Authorized Official - Phone:863-293-6507
Mailing Address - Street 1:510 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3601
Mailing Address - Country:US
Mailing Address - Phone:863-293-6507
Mailing Address - Fax:863-291-0737
Practice Address - Street 1:510 1ST ST S
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3601
Practice Address - Country:US
Practice Address - Phone:863-293-6507
Practice Address - Fax:863-291-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY235231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1770654451Medicare UPIN
FLS0887ZMedicare ID - Type Unspecified