1760555874 NPI number — PROFESSIONAL HEARING AID SERVICE, INC

Table of content: (NPI 1760555874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760555874 NPI number — PROFESSIONAL HEARING AID SERVICE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL HEARING AID SERVICE, 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:
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:
1760555874
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:
11923 CENTRE ST
Provider Second Line Business Mailing Address:
SUITE A3
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23831-1702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-796-3210
Provider Business Mailing Address Fax Number:
804-796-1112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11923 CENTRE ST
Provider Second Line Business Practice Location Address:
SUITE A3
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23831-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-796-3210
Provider Business Practice Location Address Fax Number:
804-796-1112
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
804-796-3210

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  2101-000328 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 91-05794 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com