Provider Demographics
NPI:1528162971
Name:SMITH HEARING SERVICES
Entity type:Organization
Organization Name:SMITH HEARING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-885-6166
Mailing Address - Street 1:99 CAMP MOWEEN ROAD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:CT
Mailing Address - Zip Code:06249
Mailing Address - Country:US
Mailing Address - Phone:869-885-6166
Mailing Address - Fax:869-859-0824
Practice Address - Street 1:99 CAMP MOWEEN RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:CT
Practice Address - Zip Code:06249-2704
Practice Address - Country:US
Practice Address - Phone:869-885-6166
Practice Address - Fax:869-859-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000378237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00424577Medicaid
CT12DME0884CT01OtherANTHEM BC/BS