Provider Demographics
NPI:1023116795
Name:THE HEARING CLINIC
Entity type:Organization
Organization Name:THE HEARING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MANGELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-953-2916
Mailing Address - Street 1:PO BOX 886
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24063-0886
Mailing Address - Country:US
Mailing Address - Phone:540-953-2916
Mailing Address - Fax:540-951-0302
Practice Address - Street 1:820 UNIVERSITY CITY BLVD
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-2708
Practice Address - Country:US
Practice Address - Phone:540-552-1904
Practice Address - Fax:540-951-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09445OtherMEDICARE GROUP NUMBER
VAC09445OtherMEDICARE GROUP NUMBER