Provider Demographics
NPI:1760893473
Name:MOUNTAINEER AUDIOLOGY LLC
Entity Type:Organization
Organization Name:MOUNTAINEER AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:304-822-4334
Mailing Address - Street 1:25029 NORTHWESTERN PIKE
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-6203
Mailing Address - Country:US
Mailing Address - Phone:304-822-4334
Mailing Address - Fax:304-822-4452
Practice Address - Street 1:25029 NORTHWESTERN PIKE
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-6203
Practice Address - Country:US
Practice Address - Phone:304-822-4334
Practice Address - Fax:304-822-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-0070231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty