1174927479 NPI number — AUDIOLOGY SERVICES OF WEST VIRGINIA, LLC

Table of content: (NPI 1174927479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174927479 NPI number — AUDIOLOGY SERVICES OF WEST VIRGINIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUDIOLOGY SERVICES OF WEST VIRGINIA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1174927479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2012 GARFIELD AVE STE 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKERSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26101-2539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-428-2403
Provider Business Mailing Address Fax Number:
304-428-3270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2012 GARFIELD AVE STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-2539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-428-2403
Provider Business Practice Location Address Fax Number:
304-428-3270
Provider Enumeration Date:
10/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SQUIRES
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
AUDIOLOGIST, CO-OWNER
Authorized Official Telephone Number:
304-428-2403

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  0317-A , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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