Provider Demographics
NPI:1912279530
Name:LEBANON HEARING CENTER
Entity type:Organization
Organization Name:LEBANON HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUGGER
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:765-484-8365
Mailing Address - Street 1:1125 N LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1760
Mailing Address - Country:US
Mailing Address - Phone:765-484-8365
Mailing Address - Fax:765-484-8530
Practice Address - Street 1:1125 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1760
Practice Address - Country:US
Practice Address - Phone:765-484-8836
Practice Address - Fax:765-484-8530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN40002470A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty