| Sharon Lynne Jividen, MS CCCA | |
|
508 New Hope Road, Suite #19, Princeton, WV 24740-2272 | |
| (304) 487-2487 | |
| (304) 431-3367 |
| Full Name | Sharon Lynne Jividen |
|---|---|
| Gender | Female |
| Speciality | Qualified Audiologist |
| Experience | 41 Years |
| Location | 508 New Hope Road, Princeton, West Virginia |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609843440 | NPI | - | NPPES |
| 3810001841 | Medicaid | WV | |
| 0602472 | Other | PALMETTO GBA MEDICARE PTAN NUMBER PCTN OFFICE | |
| 0602473 | Other | PALMETTO GBA MEDICARE PTAN NUMBER BLFD OFFICE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 231H00000X | Audiologist | 2201000469 (Virginia) | Secondary |
| 231H00000X | Audiologist | 2101000721 (Virginia) | Secondary |
| 231H00000X | Audiologist | A0203 (West Virginia) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Princeton Audiology Clinic Inc | 1052300357 | 2 |
| 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 |
|---|---|
| Sharon Lynne Jividen, MS CCCA 508 New Hope Road, Suite #19, Princeton, WV 24740-2272 Ph: (304) 487-2487 | Sharon Lynne Jividen, MS CCCA 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 | |
Alan Louis Desmond, AUD CCC-A Audiologist Medicare: Medicare Enrolled 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 |