Provider Demographics
NPI:1992840540
Name:HEARCARE PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:HEARCARE PROFESSIONAL CORPORATION
Other - Org Name:HEARCARE AUDIOLOGY & HEARING AID CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MA F-AAA
Authorized Official - Phone:260-485-1231
Mailing Address - Street 1:3030 LAKE AVE
Mailing Address - Street 2:SUITE #23
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5428
Mailing Address - Country:US
Mailing Address - Phone:260-485-1231
Mailing Address - Fax:260-486-6958
Practice Address - Street 1:3030 LAKE AVE
Practice Address - Street 2:SUITE #23
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5428
Practice Address - Country:US
Practice Address - Phone:260-485-1231
Practice Address - Fax:260-486-6958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN58000024A237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty