Provider Demographics
NPI:1366705816
Name:MOUNTAIN-EAR HEARING
Entity type:Organization
Organization Name:MOUNTAIN-EAR HEARING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:QUEEN
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:336-692-7691
Mailing Address - Street 1:1632 S.MARBLEHEAD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023
Mailing Address - Country:US
Mailing Address - Phone:336-692-7691
Mailing Address - Fax:
Practice Address - Street 1:63 MONTICELLO RD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9441
Practice Address - Country:US
Practice Address - Phone:828-484-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNTAIN-EAR INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1188237700000X
NC881237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1518225556OtherINDIVIDUAL NPI
NC1346508397OtherINDIVIDUAL NPI