Basic Information
| Provider Information | |||||||||
| NPI: | 1790032688 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AUDIO HEARING AID SERVICE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2630 N. WOOSTER AVE. | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303646637 | ||||||||
| FaxNumber: | 3303644343 | ||||||||
| Practice Location | |||||||||
| Address1: | 2630 N. WOOSTER AVE. | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303646637 | ||||||||
| FaxNumber: | 3303644343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2012 | ||||||||
| LastUpdateDate: | 08/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | HERBERGHS | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3303646637 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | OWNER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 2589 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 332S00000X | Y | Suppliers | Hearing Aid Equipment |
ID Information
| ID | Type | State | Issuer | Description | 000000155467 | 01 | OH | BLUE CROSS/BLUE SHIELD | OTHER | 000000197523 | 01 | OH | UNISON | OTHER | 0330917 | 05 | OH | MEDICAID | 735195 | 01 | OH | BUCKEYE COMMUNITY HEALTH PLAN | OTHER |