Advanced Audiology Associates, LLC
Organization Active NPI Audiologist · Valley Park, MO
NPI 1134528375 · NPPES record last updated Aug 13, 2014
Key facts
- NPI
- 1134528375
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Audiologist 231H00000X
- License
- 2013008765 (MO)
- Legal business name
- ADVANCED AUDIOLOGY ASSOCIATES, LLC
- Practice address
- 912 Meramec Station Rd Ste F
Valley Park, MO 63088-2045 - Phone
- (618) 939-6861
- NPI assigned
- Aug 13, 2014
- Organization subpart
- No
Authorized official
- Name
- Dr. Brandi Pettis, AU.D.
- Title
- Director of Audiology/Owner
- Phone
- (803) 549-6077
Practitioners 2
-
Kelly Kiley Knighten, AU.D., CCC-A
-
Brandi Nicole Pettis, AU.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141209000378 | MO | Part B Supplier - Clinic/Group Practice | 5395067094 |
Receives reassigned benefits from 2 practitioners Practice locations: Valley Park, MO |
National Provider Directory
Locations
912 Meramec Station Rd
Ste F
Valley Park, MO 63088
Phone (618) 939-6861
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist |
231H00000X | 2013008765 | MO | Yes |
Addresses
Primary practice location
912 Meramec Station Rd Ste F
Valley Park, MO 63088-2045
Mailing address
912 Meramec Station Rd Ste F
Valley Park, MO 63088-2045
Other providers in Valley Park, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.