Provider Demographics
NPI:1104873942
Name:CULPEPER HEARING CENTER LLC
Entity type:Organization
Organization Name:CULPEPER HEARING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MALLORY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:540-829-9005
Mailing Address - Street 1:2002 ORANGE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-4170
Mailing Address - Country:US
Mailing Address - Phone:540-829-9005
Mailing Address - Fax:
Practice Address - Street 1:2002 ORANGE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-4170
Practice Address - Country:US
Practice Address - Phone:540-829-9005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000649261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech