Basic Information
| Provider Information | |||||||||
| NPI: | 1205352341 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEARING HEALTHCARE SOLUTIONS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AUDIBEL HEARING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1751 BLUE RIDGE ROAD | ||||||||
| Address2: | |||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32789 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076015798 | ||||||||
| FaxNumber: | 4072863186 | ||||||||
| Practice Location | |||||||||
| Address1: | 2625 BARNA AVE, SUITE J | ||||||||
| Address2: | |||||||||
| City: | TITUSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212641277 | ||||||||
| FaxNumber: | 3212641242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2017 | ||||||||
| LastUpdateDate: | 01/31/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PAVONE | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | CRAIG | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2392180441 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HEARING HEALTHCARE SOLUTIONS, INC. | ||||||||
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| AuthorizedOfficialCredential: | HAS, BC-HIS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.