Provider Demographics
NPI:1750962858
Name:ELIZABETHTOWN HEARING AID CENTER, LLC
Entity type:Organization
Organization Name:ELIZABETHTOWN HEARING AID CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:COSSITT
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:270-769-6858
Mailing Address - Street 1:950 N MULBERRY ST STE 180
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3627
Mailing Address - Country:US
Mailing Address - Phone:270-769-6858
Mailing Address - Fax:270-737-6618
Practice Address - Street 1:950 N MULBERRY ST STE 180
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-3627
Practice Address - Country:US
Practice Address - Phone:270-769-6858
Practice Address - Fax:270-737-6618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100682320Medicaid