Provider Demographics
NPI:1245710292
Name:ELIZABETHTOWN HEARING AID CENTER INC
Entity type:Organization
Organization Name:ELIZABETHTOWN HEARING AID CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING INSTRUMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:STEPHAN
Authorized Official - Last Name:COSSSITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-769-6858
Mailing Address - Street 1:950 N MULBERRY ST STE 180
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3627
Mailing Address - Country:US
Mailing Address - Phone:270-769-6858
Mailing Address - Fax:
Practice Address - Street 1:950 N MULBERRY ST STE 180
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-3627
Practice Address - Country:US
Practice Address - Phone:270-317-0336
Practice Address - Fax:270-317-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101898237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty