Provider Demographics
NPI:1881851830
Name:ASHBROOK AUDIOLOGY AND HEARING AID CENTER, INC
Entity type:Organization
Organization Name:ASHBROOK AUDIOLOGY AND HEARING AID CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-666-0401
Mailing Address - Street 1:1111 SPRUCE STREET
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-4508
Mailing Address - Country:US
Mailing Address - Phone:276-666-0401
Mailing Address - Fax:276-666-0045
Practice Address - Street 1:1111 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4508
Practice Address - Country:US
Practice Address - Phone:276-666-0401
Practice Address - Fax:276-666-0045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASHBROOK AUDIOLOGY AND HEARING AID CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-19
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001212237700000X
VA2201001180231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010064481Medicaid
VA136675OtherANTHEM
VA00V792A45Medicare PIN
VAP65913Medicare UPIN