Provider Demographics
NPI:1285295774
Name:MOUNTAIN EARS HEARING CLINIC, LLC
Entity type:Organization
Organization Name:MOUNTAIN EARS HEARING CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:314-324-0097
Mailing Address - Street 1:430 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:LOWER SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:45745-8812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3901 BRISCOE RUN RD STE 10
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-8100
Practice Address - Country:US
Practice Address - Phone:314-324-0097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty