Provider Demographics
NPI:1528084704
Name:TRI-STATE AUDIOLOGY LLC
Entity type:Organization
Organization Name:TRI-STATE AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-A
Authorized Official - Phone:304-723-1592
Mailing Address - Street 1:499 COLLIERS WAY
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5011
Mailing Address - Country:US
Mailing Address - Phone:304-723-1592
Mailing Address - Fax:304-723-1594
Practice Address - Street 1:499 COLLIERS WAY
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5011
Practice Address - Country:US
Practice Address - Phone:304-723-1592
Practice Address - Fax:304-723-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AUD800OtherHEALTH PLAN OF UPPER OHIO
AUD800OtherHEALTH PLAN OF UPPER OHIO