1174696272 NPI number — HEARING CONNECTION, LLC

Table of content: (NPI 1174696272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174696272 NPI number — HEARING CONNECTION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARING CONNECTION, 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:
Provider Other Organization Name Type Code:
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:
1174696272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1005 W WALNUT ST
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98902-3360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-453-8600
Provider Business Mailing Address Fax Number:
509-453-8616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 W WALNUT ST
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-3360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-8600
Provider Business Practice Location Address Fax Number:
509-453-8616
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHEETS
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
LICENSED AUDIOLOGIST
Authorized Official Telephone Number:
509-453-8600

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7122021 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9054768 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 48169 . This is a "HEARPO PROVIDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 211431 . This is a "STATE L&I GROUP NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8931873 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9165HE . This is a "REGENCE BLUE SHIELD GRP #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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