1760609705 NPI number — INNOVATIVE AUDIOLOGY SOLUTIONS, LLC

Table of content: (NPI 1760609705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760609705 NPI number — INNOVATIVE AUDIOLOGY SOLUTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE AUDIOLOGY SOLUTIONS, 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:
1760609705
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:
290 OLD DIXIE HIGWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-562-8306
Provider Business Mailing Address Fax Number:
772-562-8127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8725 W HIGGINS RD
Provider Second Line Business Practice Location Address:
SUITE 485
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60631-2716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-537-4871
Provider Business Practice Location Address Fax Number:
772-562-8127
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SOMMERFLED
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF OPERATING OFFICE
Authorized Official Telephone Number:
772-562-8306

Provider Taxonomy Codes

  • Taxonomy code: 261QH0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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