1750606372 NPI number — ELITE AUDIOLOGY AND HEARING CARE, PLLC

Table of content: (NPI 1750606372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750606372 NPI number — ELITE AUDIOLOGY AND HEARING CARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE AUDIOLOGY AND HEARING CARE, PLLC
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:
1750606372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
541 N MOUNT JULIET RD
Provider Second Line Business Mailing Address:
SUITE 2204
Provider Business Mailing Address City Name:
MOUNT JULIET
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37122-3873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-758-7118
Provider Business Mailing Address Fax Number:
615-758-7113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
541 N MOUNT JULIET RD
Provider Second Line Business Practice Location Address:
SUITE 2204
Provider Business Practice Location Address City Name:
MOUNT JULIET
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37122-3873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-758-7118
Provider Business Practice Location Address Fax Number:
615-758-7113
Provider Enumeration Date:
04/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MCGLOTHLIN
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
ROMINE
Authorized Official Title or Position:
DOCTOR OF AUDIOLOGY
Authorized Official Telephone Number:
615-758-7118

Provider Taxonomy Codes

  • Taxonomy code: 261QH0700X , with the licence number:  1444 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332S00000X , with the licence number: 1444 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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