1558690206 NPI number — HERMISTON HEARING AID CENTER

Table of content: (NPI 1558690206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558690206 NPI number — HERMISTON HEARING AID CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERMISTON HEARING AID CENTER
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:
1558690206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 N. 1ST ST.
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
HERMISTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-567-4063
Provider Business Mailing Address Fax Number:
541-289-5064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 N. 1ST ST.
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
HERMISTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-567-4063
Provider Business Practice Location Address Fax Number:
541-289-5064
Provider Enumeration Date:
12/09/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
CRAIG
Authorized Official Title or Position:
MEMBER-LLC
Authorized Official Telephone Number:
541-567-4063

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  HAS-P-278859 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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