Provider Demographics
NPI:1982987103
Name:TRI-COUNTY AUDIOLOGY AND HEARING AID SERVICES INC
Entity type:Organization
Organization Name:TRI-COUNTY AUDIOLOGY AND HEARING AID SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-746-1133
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 1:3519 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3501
Practice Address - Country:US
Practice Address - Phone:352-746-1133
Practice Address - Fax:352-746-3474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5043332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ0158OtherBLUE CROSS BLUE SHIELDS
FL543064OtherAVAILITY