Provider Demographics
NPI:1962602276
Name:MIDDLE TENNESSEE HEARING AID CENTER
Entity type:Organization
Organization Name:MIDDLE TENNESSEE HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, CCC-A
Authorized Official - Phone:931-388-3646
Mailing Address - Street 1:102 BLYTHEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4828
Mailing Address - Country:US
Mailing Address - Phone:931-388-3646
Mailing Address - Fax:931-388-6184
Practice Address - Street 1:102 BLYTHEWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4828
Practice Address - Country:US
Practice Address - Phone:931-388-3646
Practice Address - Fax:931-388-6184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN256291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3010421OtherBLUECROSS BLUESHIELD
TN3726488Medicare PIN