Provider Demographics
NPI:1891221206
Name:TRI COUNTY HEARING AID, INC.
Entity type:Organization
Organization Name:TRI COUNTY HEARING AID, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DITCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:ACA, BC-HIS
Authorized Official - Phone:352-746-1234
Mailing Address - Street 1:3519 N LECANTO HWY
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-3501
Mailing Address - Country:US
Mailing Address - Phone:352-746-1133
Mailing Address - Fax:352-746-3474
Practice Address - Street 1:11115 SW 93RD COURT RD
Practice Address - Street 2:SUITE 600
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-3103
Practice Address - Country:US
Practice Address - Phone:352-270-2944
Practice Address - Fax:352-228-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS 1650237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000685400Medicaid