1043798960 NPI number — MHC HEARING, LLC

Table of content: (NPI 1043798960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043798960 NPI number — MHC HEARING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MHC HEARING, 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:
ELITE HEARING CENTERS OF AMERICA
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:
1043798960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 ZEBRA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM COAST
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32164-5214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-585-4583
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2459 US HIGHWAY 17 STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND HILL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31324-3767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-445-4071
Provider Business Practice Location Address Fax Number:
912-348-0166
Provider Enumeration Date:
08/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
RICE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
CURTIS
Authorized Official Title or Position:
SR VICE PRESIDENT
Authorized Official Telephone Number:
352-303-3929

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X , with the licence number:  HADE035237 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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