1871880120 NPI number — HEARING CONNECTION LLC

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 1871880120 NPI number — HEARING CONNECTION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARING CONNECTION 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:
6
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:
1871880120
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1733 GORNTO RD STE 102-E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALDOSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31601-8469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-247-4810
Provider Business Mailing Address Fax Number:
229-247-5131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1733 GORNTO RD STE 102-E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALDOSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31601-8469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-247-4810
Provider Business Practice Location Address Fax Number:
229-247-5131
Provider Enumeration Date:
07/07/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HANEY
Authorized Official First Name:
WYATT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
229-247-4810

Provider Taxonomy Codes

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

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