Basic Information
Provider Information | |||||||||
NPI: | 1538807920 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MY HEARING CENTERS, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8941 S 700 E | ||||||||
Address2: |   | ||||||||
City: | SANDY | ||||||||
State: | UT | ||||||||
PostalCode: | 840702400 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7326886486 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 600 HIGHWAY 71 S | ||||||||
Address2: |   | ||||||||
City: | MENA | ||||||||
State: | AR | ||||||||
PostalCode: | 719534738 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8882300875 | ||||||||
FaxNumber: | 8013967066 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/25/2022 | ||||||||
LastUpdateDate: | 05/25/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HAMPP | ||||||||
AuthorizedOfficialFirstName: | EILEEN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | VP | ||||||||
AuthorizedOfficialTelephone: | 7326886486 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | MY HEARING CENTERS | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/25/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X |   |   | Y |   | Suppliers | Hearing Aid Equipment |   |
ID Information
ID | Type | State | Issuer | Description | 54408416-SLS | 01 | AR | ARKANSAS STATE LICENSE | OTHER |