1548402704 NPI number — MILLENNIUM HEARING SERVICES INC.

Table of content: (NPI 1548402704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548402704 NPI number — MILLENNIUM HEARING SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLENNIUM HEARING SERVICES 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:
1548402704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4725 HOEN AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
SANTA ROSA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95405-7862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-542-1154
Provider Business Mailing Address Fax Number:
707-542-4818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4725 HOEN AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95405-7862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-542-1154
Provider Business Practice Location Address Fax Number:
707-542-4818
Provider Enumeration Date:
04/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MULVEY
Authorized Official First Name:
MARINA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
DOCTOR OF AUDIOLOGY, PRESIDENT
Authorized Official Telephone Number:
707-542-1154

Provider Taxonomy Codes

  • Taxonomy code: 237600000X , with the licence number:  AU1683 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZ229512Y . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: AU0016830 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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