Basic Information
| Provider Information | |||||||||
| NPI: | 1104906353 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DGS AUDIOLOGY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2121 ELECTRIC RD | ||||||||
| Address2: | #102 | ||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240181974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407745060 | ||||||||
| FaxNumber: | 5407748008 | ||||||||
| Practice Location | |||||||||
| Address1: | 1048 TERRACE DR | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243544138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767831827 | ||||||||
| FaxNumber: | 2767832879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 10/25/2007 | ||||||||
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| AuthorizedOfficialLastName: | SAUNDERS | ||||||||
| AuthorizedOfficialFirstName: | DARLENE | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5407745060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MS,CCCA, FAAA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 2201001085 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | DF8239 | 01 | VA | RR MEDICARE | OTHER | 181994 | 01 | VA | ANTHEM | OTHER |