1417622234 NPI number — GANT HEARING CARE

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 1417622234 NPI number — GANT HEARING CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GANT HEARING CARE
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:
6
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:
1417622234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
761 PETERS COVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNESVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28786-6594
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-734-5855
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
69 WESTRIDGE MARKET PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANDLER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28715-9174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-734-5855
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2021

Additional Information

Authorized Official

Authorized Official Last Name:
GANT
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
O
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
828-734-5855

Provider Taxonomy Codes

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

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

  • Identifier: 1780634519 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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