Provider Demographics
NPI:1750878633
Name:AUDIOLOGY CENTER, LLC
Entity type:Organization
Organization Name:AUDIOLOGY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:JARDINE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:207-664-2123
Mailing Address - Street 1:77 BEECHLAND RD
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-2539
Mailing Address - Country:US
Mailing Address - Phone:207-664-2123
Mailing Address - Fax:207-667-0706
Practice Address - Street 1:77 BEECHLAND RD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2539
Practice Address - Country:US
Practice Address - Phone:207-664-2123
Practice Address - Fax:207-667-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty