Provider Demographics
NPI:1750441689
Name:EAST LIVERPOOL SPEECH AND HEARING AID CENTER, LLC
Entity type:Organization
Organization Name:EAST LIVERPOOL SPEECH AND HEARING AID CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MALCOMSON
Authorized Official - Suffix:I
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:330-386-3277
Mailing Address - Street 1:320 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-2836
Mailing Address - Country:US
Mailing Address - Phone:330-386-3277
Mailing Address - Fax:330-386-3277
Practice Address - Street 1:320 W 5TH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-2836
Practice Address - Country:US
Practice Address - Phone:330-386-3277
Practice Address - Fax:330-386-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1160332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0629538Medicaid