Provider Demographics
NPI:1740587401
Name:ADVANCED HEARING AND AUDIOLOGY
Entity type:Organization
Organization Name:ADVANCED HEARING AND AUDIOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA, CCC-A
Authorized Official - Phone:352-671-3277
Mailing Address - Street 1:1111 NE 25TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-5675
Mailing Address - Country:US
Mailing Address - Phone:352-671-3277
Mailing Address - Fax:352-671-8164
Practice Address - Street 1:1111 NE 25TH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-5675
Practice Address - Country:US
Practice Address - Phone:352-671-3277
Practice Address - Fax:352-671-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty