Basic Information
Provider Information | |||||||||
NPI: | 1699049163 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HEARING PROFESSIONALS OF AMERICA LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3108 S ROUTE 59 | ||||||||
Address2: | SUITE 124-295 | ||||||||
City: | NAPERVILLE | ||||||||
State: | IL | ||||||||
PostalCode: | 605648021 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8886121267 | ||||||||
FaxNumber: | 8156763997 | ||||||||
Practice Location | |||||||||
Address1: | 136 W LAKE ST | ||||||||
Address2: | #110 | ||||||||
City: | BLOOMINGDALE | ||||||||
State: | IL | ||||||||
PostalCode: | 601081020 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8886121267 | ||||||||
FaxNumber: | 8156763997 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/01/2012 | ||||||||
LastUpdateDate: | 03/01/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CONREY | ||||||||
AuthorizedOfficialFirstName: | JOHN | ||||||||
AuthorizedOfficialMiddleName: | BRIAN | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER/ CEO | ||||||||
AuthorizedOfficialTelephone: | 8886121267 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | HEARING PROFESSIONALS OF AMERICA LLC | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X |   |   | Y |   | Suppliers | Hearing Aid Equipment |   |
No ID Information.