1962672170 NPI number — JACK JONES HEARING CENTER INC.

Table of content: (NPI 1962672170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962672170 NPI number — JACK JONES HEARING CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACK JONES HEARING CENTER 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:
CONNECT HEARING, INC.
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:
1962672170
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 N COMMONS DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60504-7940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-303-5380
Provider Business Mailing Address Fax Number:
630-303-5385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6809 W NW HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75225-4202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-691-5466
Provider Business Practice Location Address Fax Number:
214-691-7250
Provider Enumeration Date:
03/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VESELY
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, FINANCE AND CONTROLLING
Authorized Official Telephone Number:
630-303-5380

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112774801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0615164 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 530294 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".