Provider Demographics
NPI:1831240688
Name:HOMETOWN HEARING AND AUDIOLOGY SERVICES, LLC
Entity type:Organization
Organization Name:HOMETOWN HEARING AND AUDIOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANG
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-584-4327
Mailing Address - Street 1:115 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:47394-1822
Mailing Address - Country:US
Mailing Address - Phone:765-584-4327
Mailing Address - Fax:765-584-3677
Practice Address - Street 1:115 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-1822
Practice Address - Country:US
Practice Address - Phone:765-584-4327
Practice Address - Fax:765-584-3677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002191A237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000294346OtherANTHEM BCBS
IN200443140Medicaid