Provider Demographics
NPI:1205067113
Name:THE AUDIOLOGY CENTER OF LORAIN CO. INC
Entity type:Organization
Organization Name:THE AUDIOLOGY CENTER OF LORAIN CO. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER-AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:REYNOLDS
Authorized Official - Last Name:MITHCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA-CCCA FAAA
Authorized Official - Phone:440-246-4327
Mailing Address - Street 1:6100 S BROADWAY SUITE-102
Mailing Address - Street 2:THE AUDIOLOGY CENTER
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3875
Mailing Address - Country:US
Mailing Address - Phone:440-246-4327
Mailing Address - Fax:440-246-4327
Practice Address - Street 1:6100 S BROADWAY SUITE 102
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3875
Practice Address - Country:US
Practice Address - Phone:440-246-4327
Practice Address - Fax:440-246-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332S00000X
OHA0171231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0847329Medicaid
OHMI0410483Medicare UPIN
OHS08132Medicare PIN