Provider Demographics
NPI:1124422357
Name:SPECIAL CARE HEARING OF INDIANA LLC
Entity type:Organization
Organization Name:SPECIAL CARE HEARING OF INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGAND
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:855-259-9183
Mailing Address - Street 1:12910 SHELBYVILLE RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1593
Mailing Address - Country:US
Mailing Address - Phone:502-244-2441
Mailing Address - Fax:502-254-4086
Practice Address - Street 1:12910 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1593
Practice Address - Country:US
Practice Address - Phone:855-259-9183
Practice Address - Fax:502-254-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty