1043511918 NPI number — HEARING HEALTHCARE PROFESSIONALS OF OREGON, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043511918 NPI number — HEARING HEALTHCARE PROFESSIONALS OF OREGON, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARING HEALTHCARE PROFESSIONALS OF OREGON, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SONUS SF 0011
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043511918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 CHESHIRE PKWY N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55446-4103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-268-4115
Provider Business Mailing Address Fax Number:
763-268-4430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15405 SW 116TH AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
KING CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97224-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-684-1583
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DOTSON
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
503-684-1583

Provider Taxonomy Codes

  • Taxonomy code: 237600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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