1528487014 NPI number — HEAR IN ARIZONA LLC

Table of content: (NPI 1528487014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528487014 NPI number — HEAR IN ARIZONA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEAR IN ARIZONA 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:
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:
1528487014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39506 N DAISY MOUNTAIN DR
Provider Second Line Business Mailing Address:
122-624
Provider Business Mailing Address City Name:
ANTHEM
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85086-1663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-284-2116
Provider Business Mailing Address Fax Number:
928-496-2122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
61 BELL ROCK PLZ
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
SEDONA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86351-8810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-284-2116
Provider Business Practice Location Address Fax Number:
928-496-2122
Provider Enumeration Date:
04/10/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KELLEY
Authorized Official First Name:
DEBBIE
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER/AUDIOLOGIST
Authorized Official Telephone Number:
928-284-2116

Provider Taxonomy Codes

  • Taxonomy code: 237600000X , with the licence number:  DA1429 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1528487014 . This is a "GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1013136753 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".