Basic Information
| Provider Information | |||||||||
| NPI: | 1205266202 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERBERGHS | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 617 WABASH AVE NW | ||||||||
| Address2: | |||||||||
| City: | NEW PHILADELPHIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446634145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303646637 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4421 WHIPPLE AVE NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447182645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302449881 | ||||||||
| FaxNumber: | 3302449885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2013 | ||||||||
| LastUpdateDate: | 03/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 2589 | OH | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 026 | 01 | OH | CARESOURCE | OTHER | 0448797 | 05 | OH | MEDICAID | 735195 | 01 | OH | BUCKEYE COMMUNITY HEALTH PLAN | OTHER | 002 | 01 | OH | MEDICAL MUTUAL | OTHER | 0330917 | 05 | OH | MEDICAID | 197523 | 01 | OH | UNITED HEALTH CARE COMMUNITY PLAN | OTHER | 155467 | 01 | OH | BLUE CROSS BLUE SHIELD | OTHER |