Basic Information
| Provider Information | |||||||||
| NPI: | 1295972917 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASTRUM HEARING SOLUTIONS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1321 W SUNSET RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890146768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025668100 | ||||||||
| FaxNumber: | 7023838555 | ||||||||
| Practice Location | |||||||||
| Address1: | 1321 W SUNSET RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890146768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025668100 | ||||||||
| FaxNumber: | 7023838555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2009 | ||||||||
| LastUpdateDate: | 01/16/2009 | ||||||||
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| AuthorizedOfficialLastName: | BLAKE | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7025668100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | HIS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 1504 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.