1639565682 NPI number — PROFESSIONAL HEARING SOLUTIONS,LLC

Table of content: (NPI 1639565682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639565682 NPI number — PROFESSIONAL HEARING SOLUTIONS,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL HEARING SOLUTIONS,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:
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:
1639565682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 733
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOSCOW
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18444-0733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-476-9949
Provider Business Mailing Address Fax Number:
570-421-6038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1619 N 9TH ST
Provider Second Line Business Practice Location Address:
STROUD COMMONS
Provider Business Practice Location Address City Name:
STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18360-6501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-476-9949
Provider Business Practice Location Address Fax Number:
570-421-6038
Provider Enumeration Date:
04/07/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SHRIVE
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
570-476-9949

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X , with the licence number:  D01013 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com