Provider Demographics
NPI:1902044290
Name:MICBRO HEARING AID CENTER
Entity Type:Organization
Organization Name:MICBRO HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIESCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-842-8838
Mailing Address - Street 1:6825 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653
Mailing Address - Country:US
Mailing Address - Phone:727-842-8838
Mailing Address - Fax:727-842-6954
Practice Address - Street 1:6825 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6019
Practice Address - Country:US
Practice Address - Phone:727-842-8838
Practice Address - Fax:727-842-6954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service