Basic Information
| Provider Information | |||||||||
| NPI: | 1659642585 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RICHARD POLHILL PROFESSIONAL HEARING SOLUTIONS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AMPME, LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4550 CLYDE MORRIS BLVD STE B | ||||||||
| Address2: | |||||||||
| City: | PORT ORANGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321294080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862654769 | ||||||||
| FaxNumber: | 3862654770 | ||||||||
| Practice Location | |||||||||
| Address1: | 4550 CLYDE MORRIS BLVD STE B | ||||||||
| Address2: | |||||||||
| City: | PORT ORANGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321294080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862654769 | ||||||||
| FaxNumber: | 3862654770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2012 | ||||||||
| LastUpdateDate: | 03/29/2018 | ||||||||
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| AuthorizedOfficialLastName: | POLHILL | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | ALAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT, OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3862654769 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | HAS, BC-HIS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.