Organization Active NPI

MTC of Indiana, LTD.

Doing business as Lafayette Hearing Center

  • Audiologist
  • Lafayette, IN
National Provider Identifier
1417279472
Registry record updated Jan 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
Legal business name
MTC OF INDIANA, LTD.
Doing business as
Lafayette Hearing Center
Practice address
823 Park East Blvd
Lafayette, IN 47905-0787
Phone
(765) 448-6226
Fax
(765) 448-9416
NPI assigned
Feb 18, 2010
Last updated
Jan 13, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susan M. TauliaNPI 1447432802
Title
Owner
Phone
(765) 448-6226

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X NU Primary
Audiologist 231H00000X 23001132A IN

Addresses

Primary practice location

823 Park East Blvd
Lafayette, IN 47905-0787

Mailing address

823 Park East Blvd
Lafayette, IN 47905-0787
Phone (765) 448-6226

Other names 1

  • Lafayette Hearing Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100506000015 IN Part B Supplier - Clinic/Group Practice 9537297973 Receives reassigned benefits from 4 practitioners
Practice locations: Lafayette, IN

National Provider Directory

National Provider Directory

Locations

1800 South St
Lafayette, IN 47904
Phone (765) 448-6226

2122 Scott St
Lafayette, IN 47904
Phone (765) 448-6226

823 Park East Blvd
Lafayette, IN 47905
Phone (765) 448-6226

823 Park East Blvd
Ste H
Lafayette, IN 47905
Phone (765) 448-6226

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578873600000",
    "number": "1417279472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 PARK EAST BLVD",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479050787",
            "telephone_number": "765-448-6226",
            "fax_number": "765-448-9416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "823 PARK EAST BLVD",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479050787",
            "telephone_number": "765-448-6226",
            "fax_number": "765-448-9416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MTC OF INDIANA, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-18",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "status": "A",
        "authorized_official_last_name": "TAULIA",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "765-448-6226"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "IN",
            "license": "23001132A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lafayette Hearing Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lafayette Hearing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.