Provider Demographics
NPI:1992272553
Name:INNOVATIVE HEARING SOLUTIONS OF INDIANA, INC
Entity type:Organization
Organization Name:INNOVATIVE HEARING SOLUTIONS OF INDIANA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HERENDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-771-7109
Mailing Address - Street 1:480 W NAVAJO ST STE A
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1940
Mailing Address - Country:US
Mailing Address - Phone:765-771-7109
Mailing Address - Fax:765-770-8668
Practice Address - Street 1:750 PARK EAST BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-0788
Practice Address - Country:US
Practice Address - Phone:765-771-7109
Practice Address - Fax:765-770-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200984380Medicaid