1952674269 NPI number — MID SOUTH HEARING LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952674269 NPI number — MID SOUTH HEARING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID SOUTH HEARING 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:
1952674269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 ENTERPRISE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12095-3326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-353-4174
Provider Business Mailing Address Fax Number:
401-488-5774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8410 S 73RD PLZ
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
PAPILLION
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68046-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-331-6305
Provider Business Practice Location Address Fax Number:
402-331-6330
Provider Enumeration Date:
02/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
POPELKA
Authorized Official First Name:
CORY
Authorized Official Middle Name:
Authorized Official Title or Position:
HEARING INSTRUMENT SPECIALIST
Authorized Official Telephone Number:
402-331-6305

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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