Basic Information
| Provider Information | |||||||||
| NPI: | 1073707022 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MENENDEZ AUDIOLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 426 8TH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GLEN DALE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260381451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669213277 | ||||||||
| FaxNumber: | 3047231594 | ||||||||
| Practice Location | |||||||||
| Address1: | 499 COLLIERS WAY | ||||||||
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| City: | WEIRTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260625011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669213277 | ||||||||
| FaxNumber: | 3047231594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2007 | ||||||||
| LastUpdateDate: | 09/04/2007 | ||||||||
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| AuthorizedOfficialLastName: | MCGRATH | ||||||||
| AuthorizedOfficialFirstName: | ANN | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | INSURANCE/BILLING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 3047231592 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | A90246 | WV | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.