1366717654 NPI number — HEARING ASSOCIATES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366717654 NPI number — HEARING ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARING ASSOCIATES 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:
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:
1366717654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4905 MATTERHORN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55811-3851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-723-7880
Provider Business Mailing Address Fax Number:
218-326-6018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 HIGHWAY 55
Provider Second Line Business Practice Location Address:
CENTRAL COMMOND BLDG
Provider Business Practice Location Address City Name:
HASTINGS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55033-3734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-438-5966
Provider Business Practice Location Address Fax Number:
651-438-5960
Provider Enumeration Date:
03/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
VOSS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER/AUDIOLOGIST
Authorized Official Telephone Number:
218-723-7880

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  5119 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C03053 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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