Provider Demographics
NPI:1871955377
Name:MIAMI VALLEY HEARING AND BALANCE, LLC
Entity type:Organization
Organization Name:MIAMI VALLEY HEARING AND BALANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:937-435-5033
Mailing Address - Street 1:4720 WILMINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45440-2021
Mailing Address - Country:US
Mailing Address - Phone:937-435-5033
Mailing Address - Fax:937-435-5512
Practice Address - Street 1:4720 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440-2021
Practice Address - Country:US
Practice Address - Phone:937-435-5033
Practice Address - Fax:937-435-5512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-1009332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0155759Medicaid
OHH457790OtherMEDICARE PTAN