Provider Demographics
NPI:1770808834
Name:REVIVE HEARING CENTERS OF INDIANA LLC
Entity type:Organization
Organization Name:REVIVE HEARING CENTERS OF INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:HOWSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-570-4401
Mailing Address - Street 1:9748 LANTERN RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9612
Mailing Address - Country:US
Mailing Address - Phone:317-570-4401
Mailing Address - Fax:317-570-4403
Practice Address - Street 1:9748 LANTERN RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9612
Practice Address - Country:US
Practice Address - Phone:317-570-4401
Practice Address - Fax:317-570-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002010A237600000X, 231H00000X
IN17001288A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty