Provider Demographics
NPI:1912025123
Name:AUDIO RX HEARING SERVICES, INC.
Entity Type:Organization
Organization Name:AUDIO RX HEARING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KEANE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-A
Authorized Official - Phone:323-651-5107
Mailing Address - Street 1:350 FOX RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1308
Mailing Address - Country:US
Mailing Address - Phone:805-494-5129
Mailing Address - Fax:805-494-5258
Practice Address - Street 1:6333 WILSHIRE BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5702
Practice Address - Country:US
Practice Address - Phone:323-651-5107
Practice Address - Fax:323-651-4169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU954231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGAU000321Medicaid
CAGAU000320Medicaid
CAGAU000320Medicaid
CAW17096AMedicare PIN
CAWAU954AMedicare PIN
CAW17096Medicare PIN