Basic Information
| Provider Information | |||||||||
| NPI: | 1568897023 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FREEDOM HEARING CENTER LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | FREEDOM HEARING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 925 SW 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | CANBY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970133832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032669668 | ||||||||
| FaxNumber: | 5032669662 | ||||||||
| Practice Location | |||||||||
| Address1: | 925 SW 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | CANBY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970133832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032669668 | ||||||||
| FaxNumber: | 5032669662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2013 | ||||||||
| LastUpdateDate: | 09/03/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PALMER | ||||||||
| AuthorizedOfficialFirstName: | JUDD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5032669668 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X | 10133480 | OR | Y | Suppliers | Hearing Aid Equipment |
No ID Information.