Basic Information
| Provider Information | |||||||||
| NPI: | 1164700076 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUND SOLUTIONS HEARING CENTERS OF MINNESOTA LLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4101 W DIVISION ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563013729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202595841 | ||||||||
| FaxNumber: | 3202595845 | ||||||||
| Practice Location | |||||||||
| Address1: | 4101 W DIVISION ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563013729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202595841 | ||||||||
| FaxNumber: | 3202595845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2011 | ||||||||
| LastUpdateDate: | 07/26/2011 | ||||||||
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| AuthorizedOfficialLastName: | LAU | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3202595841 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305S00000X | 2642 | MN | Y | Managed Care Organizations | Point of Service |
No ID Information.