Basic Information
| Provider Information | |||||||||
| NPI: | 1245287036 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AUDITORY VENTURES LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HEARING AND BALANCE ASSOCIATES OF NORTHWEST FLORIDA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1875 PROFESSIONAL PARK CIR | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505534327 | ||||||||
| FaxNumber: | 8508773084 | ||||||||
| Practice Location | |||||||||
| Address1: | 1875 PROFESSIONAL PARK CIR | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505534327 | ||||||||
| FaxNumber: | 8508773084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | DEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | AUDIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 8505534327 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | AUD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0700X | AY623 AND AY 1237 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech |
ID Information
| ID | Type | State | Issuer | Description | S2663 | 01 | FL | BCBS FOR DR. RICHARD D. W | OTHER | S2680 | 01 | FL | BCBS FOR DR. JOHN H. KOON | OTHER |