Provider Demographics
NPI:1316396534
Name:MIDDLE TENNESSEE AUDIOLOGY, INC
Entity type:Organization
Organization Name:MIDDLE TENNESSEE AUDIOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOREEN
Authorized Official - Middle Name:DALY
Authorized Official - Last Name:GIBBENS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:615-447-5660
Mailing Address - Street 1:166B E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2520
Mailing Address - Country:US
Mailing Address - Phone:615-447-5660
Mailing Address - Fax:615-447-5661
Practice Address - Street 1:166B E MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2520
Practice Address - Country:US
Practice Address - Phone:615-447-5660
Practice Address - Fax:615-447-5661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA0000001570231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA0000001570OtherSTATE LICENSE