Provider Demographics
NPI:1396250007
Name:MADISON COUNTY HEARING AID CENTER
Entity type:Organization
Organization Name:MADISON COUNTY HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DISPENSER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-981-7597
Mailing Address - Street 1:3 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-1243
Mailing Address - Country:US
Mailing Address - Phone:740-852-7843
Mailing Address - Fax:740-490-7601
Practice Address - Street 1:3 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1243
Practice Address - Country:US
Practice Address - Phone:740-852-7843
Practice Address - Fax:740-490-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02325332S00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0216653Medicaid