1306186952 NPI number — EDISON STANFORD HEARING AID CENTER

Table of content: (NPI 1306186952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306186952 NPI number — EDISON STANFORD HEARING AID CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDISON STANFORD HEARING AID CENTER
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:
1306186952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 N 500 W
Provider Second Line Business Mailing Address:
SUITE 005
Provider Business Mailing Address City Name:
PROVO
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84601-1541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-373-5887
Provider Business Mailing Address Fax Number:
801-375-2293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 N 500 W
Provider Second Line Business Practice Location Address:
SUITE 005
Provider Business Practice Location Address City Name:
PROVO
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84601-1541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-373-5887
Provider Business Practice Location Address Fax Number:
801-375-2293
Provider Enumeration Date:
02/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LLOYD
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
CHRISTOPHER
Authorized Official Title or Position:
HEARING AID SPECIALIST
Authorized Official Telephone Number:
801-373-5887

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X , with the licence number:  76827944601 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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