Provider Demographics
NPI:1912441551
Name:TRICOUNTY PREMIER HEARING SERVICES INC
Entity Type:Organization
Organization Name:TRICOUNTY PREMIER HEARING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIVYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHIRBAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-561-3180
Mailing Address - Street 1:707 OAKS SHORES RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7153
Mailing Address - Country:US
Mailing Address - Phone:352-365-1593
Mailing Address - Fax:
Practice Address - Street 1:1004 N 14TH ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3850
Practice Address - Country:US
Practice Address - Phone:352-561-3180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5250237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty