1285708867 NPI number — ROSS HEARING CENTER, LLC

Table of content: (NPI 1285708867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285708867 NPI number — ROSS HEARING CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSS HEARING CENTER, 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:
1285708867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1609 E 80TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRILLVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46410-5737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-738-2730
Provider Business Mailing Address Fax Number:
219-738-2743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1609 E 80TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRILLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46410-5737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-738-2730
Provider Business Practice Location Address Fax Number:
219-738-2743
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VOELKER
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
219-738-2730

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  23001159 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000182592 . This is a "LOCAL BC BS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200310690A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5087564 . This is a "AETNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 640003968 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 02340 . This is a "HEAR USA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 352112038 . This is a "FISERV HEALTH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 397546199 . This is a "HEALTH AND WELFARE FUND" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 23001159 . This is a "UNICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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