Provider Demographics
NPI:1902641145
Name:RENEW AUDIOLOGY - HEARING AID AND TINNITUS CENTER LLC
Entity type:Organization
Organization Name:RENEW AUDIOLOGY - HEARING AID AND TINNITUS CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KASI
Authorized Official - Middle Name:C
Authorized Official - Last Name:SAUCIER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:601-645-2739
Mailing Address - Street 1:1085 GLUCKSTADT RD BLDG 500A
Mailing Address - Street 2:
Mailing Address - City:GLUCKSTADT
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9425
Mailing Address - Country:US
Mailing Address - Phone:601-645-2739
Mailing Address - Fax:601-895-0093
Practice Address - Street 1:1085 GLUCKSTADT RD BLDG 500A
Practice Address - Street 2:
Practice Address - City:GLUCKSTADT
Practice Address - State:MS
Practice Address - Zip Code:39110-9425
Practice Address - Country:US
Practice Address - Phone:601-645-2739
Practice Address - Fax:601-895-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty