1790817021 NPI number — HDN SHEPPARD ACQUISITION INC.

Table of content: (NPI 1790817021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790817021 NPI number — HDN SHEPPARD ACQUISITION INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HDN SHEPPARD ACQUISITION INC.
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:
AVADA AUDIOLOGY & HEARING CARE
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:
1790817021
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:
1905 W NORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45504-2956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-323-6129
Provider Business Mailing Address Fax Number:
937-323-6770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1905 W NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45504-2956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-323-6129
Provider Business Practice Location Address Fax Number:
937-323-6770
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHEPPARD
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
937-323-6129

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  A0327 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237600000X , with the licence number: 02601 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237600000X , with the licence number: A01389 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237600000X , with the licence number: A01460 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237600000X , with the licence number: A0306 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237700000X , with the licence number: 01339 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237700000X , with the licence number: 02306 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237700000X , with the licence number: 02216 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237700000X , with the licence number: 02263 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237700000X , with the licence number: 02728 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237700000X , with the licence number: 02409 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237700000X , with the licence number: 00525 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237700000X , with the licence number: 02232 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237700000X , with the licence number: 02299 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237700000X , with the licence number: 01774 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 0584612 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000197953 . This is a "AUDIOLOGY & DME" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4500003 . This is a "AUDIOLOGY & DME" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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