Provider Demographics
NPI:1366619272
Name:WOODMERE HEARING & BALANCE CENTERS, INC
Entity type:Organization
Organization Name:WOODMERE HEARING & BALANCE CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:941-492-4327
Mailing Address - Street 1:4120 WOODMERE PARK BLVD
Mailing Address - Street 2:SUITE 8B
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5373
Mailing Address - Country:US
Mailing Address - Phone:941-492-4327
Mailing Address - Fax:941-408-1968
Practice Address - Street 1:4120 WOODMERE PARK BLVD
Practice Address - Street 2:SUITE 8B
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5373
Practice Address - Country:US
Practice Address - Phone:941-492-4327
Practice Address - Fax:941-408-1968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY744231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1255536702Medicare PIN