Provider Demographics
NPI:1790032688
Name:AUDIO HEARING AID SERVICE LLC
Entity type:Organization
Organization Name:AUDIO HEARING AID SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:HERBERGHS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:330-364-6637
Mailing Address - Street 1:2630 N. WOOSTER AVE.
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622
Mailing Address - Country:US
Mailing Address - Phone:330-364-6637
Mailing Address - Fax:330-364-4343
Practice Address - Street 1:2630 N. WOOSTER AVE.
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622
Practice Address - Country:US
Practice Address - Phone:330-364-6637
Practice Address - Fax:330-364-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2589237700000X, 237700000X
332S00000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000155467OtherBLUE CROSS/BLUE SHIELD
OH000000197523OtherUNISON
OH0330917Medicaid
OH735195OtherBUCKEYE COMMUNITY HEALTH PLAN
OH000000155467OtherBLUE CROSS/BLUE SHIELD