Basic Information
| Provider Information | |||||||||
| NPI: | 1467448217 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEARING UNLIMITED LLC | ||||||||
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| OtherOrganizationName: | BLACK HAWK HEARING AID CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 712 | ||||||||
| Address2: | 834 W 4TH ST | ||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507040712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192344360 | ||||||||
| FaxNumber: | 3192355360 | ||||||||
| Practice Location | |||||||||
| Address1: | 834 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507022102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192344360 | ||||||||
| FaxNumber: | 3192355360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | JERRY | ||||||||
| AuthorizedOfficialMiddleName: | DEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5152331367 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 67 | IA | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 0935841 | 05 | IA | MEDICAID |