Provider Demographics
NPI:1134758550
Name:MOBILE AUDIOLOGY & HEARING AIDS LLC
Entity type:Organization
Organization Name:MOBILE AUDIOLOGY & HEARING AIDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:DESMOND
Authorized Official - Suffix:
Authorized Official - Credentials:AUDIOLOGIST MS
Authorized Official - Phone:904-445-1622
Mailing Address - Street 1:8550 TOUCHTON RD APT 2236
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2237
Mailing Address - Country:US
Mailing Address - Phone:904-445-1622
Mailing Address - Fax:904-293-1815
Practice Address - Street 1:905 BEACH BLVD STE B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4303
Practice Address - Country:US
Practice Address - Phone:904-445-1622
Practice Address - Fax:904-293-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-07
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAY2158OtherFLORIDA AUDIOLOGY LICENSE
FL102216900Medicaid