Provider Demographics
NPI:1174927479
Name:AUDIOLOGY SERVICES OF WEST VIRGINIA, LLC
Entity type:Organization
Organization Name:AUDIOLOGY SERVICES OF WEST VIRGINIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST, CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SQUIRES
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:304-428-2403
Mailing Address - Street 1:2012 GARFIELD AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-2539
Mailing Address - Country:US
Mailing Address - Phone:304-428-2403
Mailing Address - Fax:304-428-3270
Practice Address - Street 1:2012 GARFIELD AVE STE 4
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2539
Practice Address - Country:US
Practice Address - Phone:304-428-2403
Practice Address - Fax:304-428-3270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0317-A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVE145Medicare UPIN