Basic Information
| Provider Information | |||||||||
| NPI: | 1073721957 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WEST COAST HEARING LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MIRACLE EAR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 ENTERPRISE RD | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120953326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013534174 | ||||||||
| FaxNumber: | 4014885774 | ||||||||
| Practice Location | |||||||||
| Address1: | 672 WEST 11TH STREET | ||||||||
| Address2: | |||||||||
| City: | TRACY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953760000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098399730 | ||||||||
| FaxNumber: | 2098366007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 01/04/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STEELE | ||||||||
| AuthorizedOfficialFirstName: | KAYLA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | INSURANCE COORDINATO | ||||||||
| AuthorizedOfficialTelephone: | 4013534174 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | HT8249 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 332S00000X | 9287 | CA | Y | Suppliers | Hearing Aid Equipment |
No ID Information.