1568633196 NPI number — HEALTHDRIVE AUDIOLOGY CORPORATION

Table of content: (NPI 1568633196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568633196 NPI number — HEALTHDRIVE AUDIOLOGY CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHDRIVE AUDIOLOGY CORPORATION
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:
HEALTHDRIVE AUDIOLOGY GROUP
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:
1568633196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 CROSSING BLVD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
FRAMINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01702-5555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-964-6681
Provider Business Mailing Address Fax Number:
617-630-0141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 S 3RD ST STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43215-4206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-964-6681
Provider Business Practice Location Address Fax Number:
888-662-0859
Provider Enumeration Date:
03/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
BANKS
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
857-255-0486

Provider Taxonomy Codes

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

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





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