Provider Demographics
NPI:1548516354
Name:PATRIOT CENTER FOR HEARING LOSS & RELATED DISORDERS, LLC
Entity type:Organization
Organization Name:PATRIOT CENTER FOR HEARING LOSS & RELATED DISORDERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPP
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:865-471-0466
Mailing Address - Street 1:661 E BROADWAY BLVD, STE C
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760
Mailing Address - Country:US
Mailing Address - Phone:865-471-0466
Mailing Address - Fax:865-471-0468
Practice Address - Street 1:661 E BROADWAY BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760
Practice Address - Country:US
Practice Address - Phone:865-471-0466
Practice Address - Fax:865-471-0468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X, 231H00000X
TN1162261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ046151Medicaid
TN4091430OtherBLUECROSS BLUE SHIELD OF TN