Provider Demographics
NPI:1205974912
Name:ROYAL HEARING CENTER INC
Entity type:Organization
Organization Name:ROYAL HEARING CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MUSTAFAGA
Authorized Official - Suffix:
Authorized Official - Credentials:BA NBC HIS
Authorized Official - Phone:330-454-6141
Mailing Address - Street 1:1139 12TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-1905
Mailing Address - Country:US
Mailing Address - Phone:330-454-6141
Mailing Address - Fax:330-454-9255
Practice Address - Street 1:1139 12TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-1905
Practice Address - Country:US
Practice Address - Phone:330-454-6141
Practice Address - Fax:330-454-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00725237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005487084OtherAETNA
000000155436OtherANTHEM BCBS
OH0597635Medicaid
=========002OtherMEDICAL MUTUAL OF OHIO