1922203298 NPI number — MIDWEST AUDIOLOGY INC.

Table of content: (NPI 1922203298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922203298 NPI number — MIDWEST AUDIOLOGY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST AUDIOLOGY 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:
1922203298
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:
109 POOLER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEKALB
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60115-4626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
181-575-1224
Provider Business Mailing Address Fax Number:
815-754-0993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 N GALENA AVE
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
DIXON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61021-2115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-288-1111
Provider Business Practice Location Address Fax Number:
815-288-1111
Provider Enumeration Date:
06/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FOGEL
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
RAMSEY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
815-288-1111

Provider Taxonomy Codes

  • Taxonomy code: 231HA2400X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03803 . This is a "HEARUSA, HEARING CARE NET" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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