1770927550 NPI number — AUDIOLOGY DISTRIBUTION

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 1770927550 NPI number — AUDIOLOGY DISTRIBUTION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUDIOLOGY DISTRIBUTION
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:
HEARUSA
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:
1770927550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10455 RIVERSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM BEACH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33410-4237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-478-8770
Provider Business Mailing Address Fax Number:
561-598-7230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
697 HOPEWELL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEATH
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43056-1579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-788-6054
Provider Business Practice Location Address Fax Number:
740-344-9480
Provider Enumeration Date:
04/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MORALES
Authorized Official First Name:
LILLIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTRACTING MANAGER
Authorized Official Telephone Number:
561-478-8770

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  03102 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0079935 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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