1437239647 NPI number — DOTHAN HEARING AID CENTER, INC.

Table of content: ROBIN ABRAHAM MATHEW APN (NPI 1699143461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437239647 NPI number — DOTHAN HEARING AID CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOTHAN HEARING AID 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:
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:
1437239647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2815 ROSS CLARK CIR
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36301-2016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-794-2294
Provider Business Mailing Address Fax Number:
334-792-5361

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2815 ROSS CLARK CIR
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36301-2016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-794-2294
Provider Business Practice Location Address Fax Number:
334-792-5361
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOOD
Authorized Official First Name:
TROY
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
PRES./OWNER
Authorized Official Telephone Number:
334-794-2294

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  4046 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51056823 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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