1477623502 NPI number — DOCTORS HEARING CENTER LLC LXI

Table of content: (NPI 1477623502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477623502 NPI number — DOCTORS HEARING CENTER LLC LXI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS HEARING CENTER LLC LXI
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:
1477623502
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:
2227 WEST MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-985-9944
Provider Business Mailing Address Fax Number:
501-985-6590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 FAIRWAY DRIVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DEERFIELD BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-354-3738
Provider Business Practice Location Address Fax Number:
954-354-0171
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PARTNER OFFICER
Authorized Official Telephone Number:
501-985-9944

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com