Provider Demographics
NPI:1306085410
Name:ALBEMARLE AUDIOLOGY, PLLC
Entity type:Organization
Organization Name:ALBEMARLE AUDIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-A
Authorized Official - Phone:252-331-1494
Mailing Address - Street 1:PO BOX 2443
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27906-2443
Mailing Address - Country:US
Mailing Address - Phone:252-331-1494
Mailing Address - Fax:252-331-0308
Practice Address - Street 1:330 CAMDEN CSWY
Practice Address - Street 2:SUITE C
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-6811
Practice Address - Country:US
Practice Address - Phone:252-331-2437
Practice Address - Fax:252-331-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA841261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
1538315338OtherNPI FOR THOMAS HENDERSON