Basic Information
| Provider Information | |||||||||
| NPI: | 1518674423 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHEAST HEARING PARTNERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 851 BROKEN SOUND PKWY NW STE 120 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334873638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613671623 | ||||||||
| FaxNumber: | 5612995438 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 W ROLLING XRDS STE 209 | ||||||||
| Address2: | |||||||||
| City: | CATONSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212286211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107880440 | ||||||||
| FaxNumber: | 5612995438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2022 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | MANOR | ||||||||
| AuthorizedOfficialFirstName: | LEAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CORPORATE INSURANCE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5613671623 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SOUTHEAST HEARING PARTNERS, LLC | ||||||||
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| NPICertificationDate: | 10/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist | 237700000X | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.