Provider Demographics
NPI:1073686564
Name:THAYNE A HEDGES REGIONAL SPEECH AND HEARING CENTER INC
Entity type:Organization
Organization Name:THAYNE A HEDGES REGIONAL SPEECH AND HEARING CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-234-3734
Mailing Address - Street 1:2615 E RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-4670
Mailing Address - Country:US
Mailing Address - Phone:580-234-3734
Mailing Address - Fax:580-234-2615
Practice Address - Street 1:2615 E RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-4670
Practice Address - Country:US
Practice Address - Phone:580-234-3734
Practice Address - Fax:580-234-2615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK90231H00000X
OK2181235Z00000X
OK114235Z00000X
OK2948235Z00000X
OK53235Z00000X
OK2571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100664980AMedicaid
OK100757400AMedicaid
OK100662450BMedicaid
OK100653300BMedicaid
OK100659190AMedicaid
OK100757400EMedicaid
OK100660610AMedicaid
OK100757400BMedicaid
OK200013580AMedicaid
OK100757400CMedicaid