1235519679 NPI number — PURE SOUND HEARING CENTERS, LLC.

Table of content: (NPI 1235519679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235519679 NPI number — PURE SOUND HEARING CENTERS, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PURE SOUND HEARING CENTERS, 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:
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:
1235519679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10935 SE 177TH PL
Provider Second Line Business Mailing Address:
203
Provider Business Mailing Address City Name:
SUMMERFIELD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34491-8975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-245-2333
Provider Business Mailing Address Fax Number:
352-245-2338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10935 SE 177TH PL
Provider Second Line Business Practice Location Address:
203
Provider Business Practice Location Address City Name:
SUMMERFIELD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34491-8975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-245-2333
Provider Business Practice Location Address Fax Number:
352-245-2338
Provider Enumeration Date:
06/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ALTOM
Authorized Official First Name:
AUGUST
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
352-245-2333

Provider Taxonomy Codes

  • Taxonomy code: 261QH0700X , with the licence number:  AS2800 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332S00000X , with the licence number: AS2800 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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