Provider Demographics
NPI:1891771655
Name:HEARING CENTER LLC
Entity Type:Organization
Organization Name:HEARING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HERR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-207-1675
Mailing Address - Street 1:1306 APPLE GLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1792
Mailing Address - Country:US
Mailing Address - Phone:260-459-6924
Mailing Address - Fax:260-459-6200
Practice Address - Street 1:1306 APPLE GLEN BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1792
Practice Address - Country:US
Practice Address - Phone:260-459-6924
Practice Address - Fax:260-459-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100312300Medicaid
IN100312300AMedicaid
IN100312300AMedicaid