Basic Information
| Provider Information | |||||||||
| NPI: | 1558690206 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HERMISTON HEARING AID CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 N. 1ST ST. | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | HERMISTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415674063 | ||||||||
| FaxNumber: | 5412895064 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 N. 1ST ST. | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | HERMISTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415674063 | ||||||||
| FaxNumber: | 5412895064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2009 | ||||||||
| LastUpdateDate: | 12/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | CRAIG | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER-LLC | ||||||||
| AuthorizedOfficialTelephone: | 5415674063 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | BC-HIS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HAS-P-278859 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.