| Alan Louis Desmond, AUD CCC-A | |
|
508 New Hope Road, Suite #19, Princeton, WV 24740-2272 | |
| (304) 487-2487 | |
| (304) 431-3367 |
| Full Name | Alan Louis Desmond |
|---|---|
| Gender | Male |
| Speciality | Audiologist |
| Location | 508 New Hope Road, Princeton, West Virginia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275501439 | NPI | - | NPPES |
| 9460000000 | Medicaid | WV | |
| DE0534283 | Other | PALMETTO GBA MEDICARE PTAN NUMBER BLFD OFFICE | |
| 9450513 | Medicaid | VA | |
| DE0534282 | Other | PALMETTO GBA MEDICARE PTAN NUMBER PCTN OFFICE | |
| 640000237 | Other | RR MEDICARE PALMETTO GBA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 231H00000X | Audiologist | A0074 (West Virginia) | Primary |
| 231H00000X | Audiologist | 2201000219 (Virginia) | Secondary |
| 231H00000X | Audiologist | 447 (West Virginia) | Secondary |
| Provider Name | Princeton Audiology Clinic Inc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1073580817 PECOS PAC ID: 1052300357 Enrollment ID: O20040511001102 |
| Mailing Address | Practice Location Address |
|---|---|
| Alan Louis Desmond, AUD CCC-A 508 New Hope Road, Suite #19, Princeton, WV 24740-2272 Ph: (304) 487-2487 | Alan Louis Desmond, AUD CCC-A 508 New Hope Road, Suite #19, Princeton, WV 24740-2272 Ph: (304) 487-2487 |
Princeton Audiology Clinic, Inc., Audiologist Medicare: Medicare Enrolled Practice Location: 508 New Hope Road, Suite #19, Princeton, WV 24740 Phone: 304-487-2487 Fax: 304-431-3367 | |
Sharon Lynne Jividen, MS CCCA Audiologist Medicare: Accepting Medicare Assignments Practice Location: 508 New Hope Road, Suite #19, Princeton, WV 24740 Phone: 304-487-2487 Fax: 304-431-3367 | |
Mrs. Lindsey Shea Underwood, AU.D., CCC-A Audiologist Medicare: Accepting Medicare Assignments Practice Location: 508 New Hope Road, Suite #19, Princeton, WV 24740 Phone: 304-487-2487 Fax: 304-431-3367 | |
Tara Janae Minnix-harmon, AU.D., CCC-A Audiologist Medicare: Accepting Medicare Assignments Practice Location: 508 New Hope Road, Suite #19, Princeton, WV 24740 Phone: 304-487-2487 Fax: 304-431-3367 |