1043595333 NPI number — MR. RICHARD JOE DAVIS HEARING AID DEALER

Table of content: MR. RICHARD JOE DAVIS HEARING AID DEALER (NPI 1043595333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043595333 NPI number — MR. RICHARD JOE DAVIS HEARING AID DEALER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
RICHARD
Provider Middle Name:
JOE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
HEARING AID DEALER
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIS
Provider Other First Name:
RICK
Provider Other Middle Name:
JOE
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
HEARING AID DEALER
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1043595333
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
703 E ALAMEDA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POCATELLO
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83201-3659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-234-1330
Provider Business Mailing Address Fax Number:
208-233-4234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 E ALAMEDA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83201-3659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-234-1330
Provider Business Practice Location Address Fax Number:
208-233-4234
Provider Enumeration Date:
10/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  HA11 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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