Provider Demographics
NPI:1972666519
Name:NUTONE HEARING AID CENTER
Entity Type:Organization
Organization Name:NUTONE HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:304-624-0530
Mailing Address - Street 1:756 W PIKE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2649
Mailing Address - Country:US
Mailing Address - Phone:304-624-0530
Mailing Address - Fax:304-624-7091
Practice Address - Street 1:756 W PIKE ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2649
Practice Address - Country:US
Practice Address - Phone:304-624-0530
Practice Address - Fax:304-624-7091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV924332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1069073Medicare UPIN