Basic Information
| Provider Information | |||||||||
| NPI: | 1700975935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANK | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | BC-HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17167 | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018240570 | ||||||||
| FaxNumber: | 6018240490 | ||||||||
| Practice Location | |||||||||
| Address1: | 1417 23RD AVE | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568948331 | ||||||||
| FaxNumber: | 6016936676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 10/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HA0582 | MS | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | 4030 | AL | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 510-77181ALA | 01 | AL | BC BS | OTHER |