Basic Information
| Provider Information | |||||||||
| NPI: | 1740860485 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EGBERT | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | RALPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 ENTERPRISE RD | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120953326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013534174 | ||||||||
| FaxNumber: | 4014885774 | ||||||||
| Practice Location | |||||||||
| Address1: | 4793 VILLAGE SQUARE DR # 140 | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420017435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704440448 | ||||||||
| FaxNumber: | 2704440449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2021 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 243281 | KY | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.