1881978997 NPI number — CUSTOM HEARING SOLUTIONS

Table of content: (NPI 1881978997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881978997 NPI number — CUSTOM HEARING SOLUTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUSTOM HEARING SOLUTIONS
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:
1881978997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8712 WYOMING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68122-5245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-515-9228
Provider Business Mailing Address Fax Number:
866-826-9730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8712 WYOMING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68122-5245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-515-9228
Provider Business Practice Location Address Fax Number:
866-826-9730
Provider Enumeration Date:
10/07/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ORESKOVICH
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER/OPERATOR
Authorized Official Telephone Number:
402-515-9228

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  900773 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237700000X , with the licence number: 900773 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 10026089200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".